THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 

MRS.  PRUDENCE  W.  KOFOID 


ESSENTIALS  OF  VACCINATION ; 


\^^ 


(    A   COMPILATION    OF 


Facts  Relating  to  Vaccine  Inoculation  and 
ITS  Influence  in  the  Prevention  of 


SMALL-POX.  ) 


BY 


W.  A.  HARDAWAY,  M.D., 

Professor  of  Diseases  of  the  Skin  in  the  Post-Graduate  FACUL^l^ 'ii-^      "' 
THE  Missouri  Medical  College,  St.  Louis;  Member  of  tme      '       ^   ^ 
American  Dermatological  Association  ;  formerly 
one  of  the  Vaccine  Physicians  to 

the  City  of  St.  Louis.  ^ 


CHICAGO  : 
JANSEN,  McCLURG  &  COMPANY. 

1882. 


(^K41 


V)~ 


Copyright. 

By  JANSEN,  McCLURG  &  CO. 

A.D.  1882. 


'^> 


H  ^^ 

E>  \o  (o 

Lib '/.a 


•  These  pages  are  respectftdly  Z7tscrzbed  to 
gr.  Jfnink  f  ♦  Jfost^r,  of  New  York  City,  in 
appreciation  of  his  many  scientific  a7id  prac- 
tical labors  in  the  cause  of  Vaccination, 


PREFACE 


This  little  volume  is,  of  course,  not  intended  to  be 
a  comprehensive  treatise  on  Vaccination ;  but  I  believe 
that  a  careful  compilation  of  the  more  essential  facts 
relating  to  this  all-important  subject  will  not  prove  un- 
acceptable to  the  profession. 

This  conviction  is  strengthened  by  the  knowledge 
that  much  of  the  literature  bearing  on  Vaccination  in 
its  modern  aspects,  especially  Animal  Vaccination,  is 
more  or  less  inaccessible  to  the  general  reader. 

As  the  practical  administration  of  Vaccination  in 
America  differs  to  some  extent  from  the  customs  pre- 
vailing in  Europe,  it  will  be  found  that  this  fact  has 
been  given  due  consideration. 

I  have  availed  myself  freely,  and  in  many  instances 
literally,  of  the  labors  of  eminent  vaccinologists  in  this 
country  and  abroad;  but  I  believe  that  due  acknowl- 
edgment has  been  made  in  every  case. 

W.  A.  H. 


TABLE  OF  CONTENTS. 


CHAPTER  I. 

HISTORY  OF  VACCINATION. 

Inoculation  for  Small-pox — Jenner  and  Vaccina- 
tion^— Animal  Vaccination 9 

CHAPTER  H. 

VARIOLA  IN  ANIMALS. 

General  Considerations — Natural  Cow-pox — Horse- 
pox — Sheep-pox,  etc 17 

CHAPTER  HI. 

NATURE  OF  VACCINIA. 

Relationship  of  Cow-pox  and  Horse-pox  to  Hu- 
man Variola — Contagium  of  Vaccine  Virus  and 
Mode  of  Infection 29 

CHAPTER  IV. 

VACCINIA  IN  THE  HUMAN  SUBJECT. 

Symptoms  and  Course  —  Normal  Deviations  — 
Bryce's  Test — Vaccinia  after  Small-pox — Vac- 
cinia Revived — Insusceptibility  of  Vaccinia. ...     40 

5 


6  TABLE   OF  CONTENTS. 


CHAPTER  V. 

ABNORMAL    MODIFICATIONS  AND  COMPLI- 
CATIONS OF  VACCINIA. 

Spurious  Vaccinia — Erysipelas  after  Vaccination — 
Influence  of  Mechanical  Interference  —  Glandu- 
lar Involvements,  etc. —  Otitis  Media  Suppura- 
tiva after  Vaccination — Vaccinal  Eruptions — 
Eczema  after  Vaccination — Generalized  Vac- 
cinia-^ Vaccinal  Syphilis  —  Influence  of  other 
Diseases  on  Vaccinia  —  Causes  of  Vaccinal  Ir- 
regularities and   Complications 48 


CHAPTER  VI. 

REVACCINATION. 

Course  of  Vaccination — What  Constitutes  a  Re- 
vaccination  ? — How  Often  Should  Revaccination 
be  Performed  1 64 


CHAPTER  VH. 

MERITS  OF  DIFFERENT  KINDS  OF  VACCINE 

VIRUS. 

General  Considerations  —  Has  the  Prophylactic 
Power  of  Vaccinia  Diminished  ? — Disadvantages 
of  Humanized  Virus  —  Advantages  of  Bovine 
Virus — Disadvantages  of  Bovine  Virus 71 


TAB^E  OF  CONTENTS. 


CHAPTER  VIII. 

METHODS  OF  OBTAINING  AND  STORING 
VACCINE  VIRUS. 

Propagation  of  Bovine  Virus — Collection  and  Stor- 
age of  Bovine  Virus  —  Methods  of  Obtaining 
Humanized  Virus — Various  Modes  of  Storage 
of  Humanized  Virus 84 


CHAPTER  IX. 

THE  OPERATION  OF  VACCINATING. 

General  Considerations — Condition  of  the  Person 
to  be  Vaccinated — Age — Circumstances  which 
Demand  the  Immediate  Performance  of  Vacci- 
nation— Performance  of  the  Operation — Inspec- 
tion of  Results 99 


CHAPTER  X. 

EXAMINATION  OF  THE  OBJECTIONS  TO 
VACCINATION. 

General  Considerations  —  Protection  Afforded  by 
Vaccination  against  Small-pox  —  Alleged  Dan- 
gers of  Vaccination 116 


ESSENTIALS  OF  VACCINATION 


CHAPTER  I. 


HISTORY  OF  VACCINATION. 

Inoculation  for  Small-Pox. — A  crude 
theory  of  preventive  viruses,  the  highest  de- 
velopment of  which  we  have  but  to-day  wit- 
nessed at  the  hands  of  Pasteur,  has  perhaps 
been  in  existence  for  many  centuries  ;  at  any 
rate,  the  practice  of  inoculating  for  small- 
pox boasts  of  a  somewhat  remote  antiquity. 
It  is  said  that  this  operation  was  employed 
in  China  and  India  as  early  as  the  eleventh 
century.  Dr.  George  Gregory'^'  states  that 
about  the  year  1703,  rumors  of  the  great 
success  of  this  operation  attracted  the  atten- 
tion of  Timoni,  a  Greek  physician,  a  graduate 
of  Oxford.  Further  observation  having  con- 
vinced him  of  the  importance  of  the  method, 
in  1 713  he  wrote  an  account  of  inoculation 
to    an    English    correspondent,    which  was 

*  Cyclop.  Pract.  Med.,  vol.  iii,  p.  748;  London,  1835. 


10  ESSENTIALS  OF  VACCINATION. 

afterward  published  in  the  Philosophical 
Transactions.  In  1715,  Dr.  Pylarini,  the 
Venetian  consul  at  Smyrna,  published  an  ac- 
count of  it  at  Venice ;  a  notice  of  this  work 
also  appeared  in  the  Transactions.  These 
favorable  reports  were  corroborated  by  Mr. 
Kennedy,  an  English  surgeon,  who  had  trav- 
eled in  the  East,  in  an  Essay  on  External 
Remedies,  published  in  London  in  1715. 
These  important  facts  were  quite  forgotten 
in  England  till  attention  was  again  called  to 
the  subject  by  the  famous  letter  of  Lady 
Mary  Wortley  Montague,  dated  April  i, 
1 71  7.*  While  all  praise  is  due  to  that  dis- 
tinguished woman  for  her  acute  intellect  and 
great  moral  courage,  her  daughter  affording 
the  first  example  of  inoculation  in  England, 
it  should  not  be  forgotten  that  the  practice 
had  been  first  urged  by  medical  men.f 

Jenner  and  Vaccination. — It  is  quite 
probable  that  the  prophylactic  influence  of 

*  Letters  of  the  Right  Hon.  Lady  Mary  Wortley  Montague  ; 
Leipsic,  1835. 

f  As  there  are  certain  circumstances  that  might  arise  in  which 
inoculation  would  be  necessary  (see  Trousseau,  Clin.  Med., and 
Marson,  Reynolds'  System),  it  will  not  be  amiss  to  state  that 
the  variolous  lymph  should  be  taken  when  limpid,  on  about  the 
fifth  or  sixth  day  of  the  eruption,  selected  from  a  mild  case,  and 
put  into  the  arm  in  but  one  place. 


HISTORY  OF  VACCINATION,  11 

vaccinia  against  variola  has  been  matter  of 
tradition  among  the  common  people.  Hum- 
boldf^  declares  that  among  the  mountaineers 
of  Mexico  this  knowledge  has  long  been 
known  and  acted  upon.  Sulzer,  in  1713, 
and  Sutton  and  Fewster,  in  1765,  are  said 
to  have  first  called  attention  to  this  property 
of  vaccine  in  Europe.f  In  1791,  a  school- 
master of  Holstein,  named  Plett,  is  reported 
as  having  inoculated  three  children  with  vac- 
cine virus.  There  is  no  sort  of  question  that 
Benjamin  Jesty,  "  an  honest  and  upright 
man," a  farmer  of  Gloucestershire,  vaccinated 
his  wife  and  two  children  in  17744  Cut  all 
these  circumstances  detract  nothing  from 
the  glory  of  the  scientific  discoverer  and  sys- 
tematic promoter  of  vaccination.  Edward 
Jenner  was  born  at  the  vicarage  of  Berkeley, 
in  Gloucestershire,  on  the  17th  of  May,  1749. 
While  engaged  as  an  apprentice  to  Mr.  Lud- 
low, of  Sodbury,  the  attention  of  Jenner 
was  frequently  attracted  to  a  popular  belief, 
current  in  the  neighborhood,  that  cows  were 

*  Ziemssen's  Encyclop.  Pract.  Med.,  vol.  ii,  p.  401;  New 
York,  1875. 

f  Ziemssen,  loc.  cit.,  and  Hebra,  Dis.  of  Skin;   London,  i860. 

X  Trousseau,  in  his  fascinating  chapter  on  Vaccination,  gives 
a  full  history  of  Jesty's  connection  with  the  subject. 


12  ESSENTIALS  OF  VACCINATION, 


subject  to  an  affection  called  the  cow-pox, 
which  was  sometimes  contracted  by  the  milk- 
ers, who,  in  consequence,  acquired  an  im- 
munity from  small-pox.  On  one  occasion  a 
young  woman  came  into  the  surgery  for 
advice  while  the  subject  of  variola  was  being 
discussed.  Upon  hearing  the  conversation, 
she  exclaimed  :  ''  I  cannot  take  that  disease 
for  I  have  had  cow-pox."  This  incident  cre- 
ated a  deep  impression  upon  young  Jenner  s 
mind.  Afterward,  when  he  became  a  stu- 
dent of  Hunter's,  he  mentioned  these  various 
circumstances  to  the  master,  but  met  with  lit- 
tle encouragement  from  him.  It  is  not  neces- 
sary to  follow  step  by  step  the  road  pursued 
by  Jenner  till  he  reached  the  ultimate  goal 
of  his  immortal  discovery.  The  story  has 
been  repeated  many  times."^  Suffice  it  to  say 
that  when  he  settled  in  practice  in  Glouces- 
tershire (1775),  he  discovered  many  persons 
insusceptible  of  variolous  inoculation.  On 
the  other  hand,  there  were  others  who  had 
apparently  suffered  from  cow-pox,  but  who 
afterward  received  small-pox  in  the  usual 
way.  After  many  difficulties  and  much 
painstaking  research,  he  ascertained  that  the 

*  See  Baron's  Life  of  Jenner.  2  vols.:  London.  ifiaR 


HISTORY  OF  VACCINATION.  13 

COW  was  subject  to  a  number  of  eruptive  dis- 
orders, which  had  all  received  the  name  of 
cow-pox.  He  then  came  to  understand  the 
apparent  contradictions  in  the  results  of  in- 
oculation. After  learning  to  distinguish  be- 
tween true  and  spurious  vaccinia,  it  occurred 
to  him  that  the  cow-pox  presented  successive 
stages,  and  that  it  was  only  at  one  period  of 
its  course  that  its  virus  was  prophylactic 
against  small-pox.  Finally  his  philosophic 
mind  reached  the  conclusion  that  it  might 
be  possible  to  propagate  the  disease  by  in- 
oculating first  from  the  cow  and  then  from 
one  human  being  to  another.  On  the  14th 
of  May,  1796,  Jenner  vaccinated  his  first  pa- 
tient. James  Phipps,  aged  eight  years,  was 
inoculated  with  matter  taken  from  the  hands 
of  Sarah  Nelmes.  He  passed  through  the 
disease  in  a  satisfactory  manner,  and  was 
tested  on  the  ist  of  July  following  by  small- 
pox inoculation,  without  effect.  Jenner's 
first  essay  was  published  in  London,  in  June, 
1798,  and  was  entitled*' An  Enquiry  into  the 
Causes  and  Effects  of  the  Variolae  Vaccinae, 
a  disease  discovered  in  some  of  the  western 
counties  of  England,  particularly  Glouces- 
tershire, and  known  by  the  name  of  cow-pox." 


14  ESSENTIALS  OF  VACCINATION, 

As  a  matter  of  course,  the  early  career  of 
vaccination  met  with  much  bitter  opposition, 
not  only  from  the  laity,  but  also  from  medi- 
cal men.  However,  in  spite  of  all  drawbacks, 
the  cause  advanced  with  rapidity.  Jenner 
states  that  in  1801  more  than  six  thousand 
persons  had  been  vaccinated,  the  greater 
number  of  whom  had  been  tested  by  inocu- 
lation, and  exposed  to  the  infection  of  small- 
pox in  every  way  that  could  be  devised, 
without  effect.  In  our  modern  estimation 
of  the  value  of  vaccination,  these  early  rig- 
orous experimental  tests  should  not  be  for- 
gotten. Vaccination  was  introduced  into 
America  by  Dr.  Waterhouse,  of  Cambridge, 
in  1796,  the  year  of  Jenner's  first  vaccine 
inoculation.  That  physician's  observations 
and  the  works  of  Coxe  and  Scofield  may  be 
yet  read  with  interest  and  profit.  Thomas 
Jefferson  was  an  ardent  advocate  and  pro- 
moter of  the  new  practice.  In  1800,  vacci- 
nation was  introduced  into  France.  Dr. 
Luigi  Sacco,  of  Milan,  was  an  early  worker 
in  the  same  field,  and  made  many  investiga- 
tions into  the  pathology  of  cow-pox  and  the 
analogous  pox  of  other  animals.  Dr.  De 
Carro,  of  Vienna,  was  an  active  propagator 


HISTORY  OF  VACCINATION.  15 

of  the  new  doctrine  on  the  continent  of 
Europe.  After  many  difficulties,  vaccine 
was  transported  to  various  quarters  of  the 
globe,  and  the  art  of  vaccination  became 
general  over  the  civilized  world.  Dr.  Jenner 
died  in  1823.  In  addition  to  the  names 
mentioned  above,  no  sketch  of  the  history  of 
vaccination  would  be  complete  without  ref- 
erence to  the  works  of  Woodville,  Pearson, 
Dunning,  the  originator  of  the  words  vaccz- 
7iatio7i  and  to  vaccinate,  Ring,  Robt.  Willan, 
and  a  host  of  others  among  the  early,  and 
Ceely,  Bousquet,  Steinbrenner,  Hering,  Mar- 
son,  Simon  and  Seaton  among  the  compara- 
tively recent  investigators. 

Animal  Vaccination. — In  our  own  day 

a  new  page  in  the  study  of  vaccination  has 
been  unfolded,  which,  perhaps,  affords  some 
problems  not  yet  thoroughly  solved.  By 
animal  vaccination,  in  the  true  sense,  is  to 
be  understood,  according  to  Dr.  Martin,"^  the 
inoculation  of  a  young  selected  animal  of 
the  bovine  species,  from  an  original  sponta- 
neous case  of  cow-pox,  from  this  others,  and 
so  on  in  a  continuous  series.      He  calls  the 

*  Trans.  Am.  Med.  Ass'n,  vol.  xxviii,  p.  196,  1877. 


16  ESSENTIALS  OF  VACCINATION. 

lymph   secured   in   that  way    ''heifer-trans- 
mitted cow-pox  virus." 

•  Before  the  year  1866,  outside  of  Italy, 
the  practice  of  calf-to-calf  vaccination  was 
nowhere  pursued,  and,  in  fact,  was  practically 
unknown."^'  In  that  country,  at  a  very  early 
date,  animal  vaccination  had  been  advocated. 
Although  the  modern  era  of  animal  vaccir 
nation  may  be  said  to  have  owed  its  birth  to 
the  address  delivered  by  Dr.  Palasciano  to 
the  Medical  Congress  at  Lyons ;  it  was  not 
till  the  discovery  of  the  case  of  cow-pox  at 
Beaugency  that  this  mode  of  practice  re- 
ceived the  tremendous  impulse  which  has 
ended  in  establishing  it  in  many  countries, 
and  almost  exclusively  in  America.  In 
1870,  Dr.  Henry  A.  Martin,  of  Boston,  the 
indefatigable  and  able  promoter  of  the 
science  and  art  of  vaccination,  secured  frorn 
Depaul  virus  taken  from  the  258th,  259th 
and  260th  of  his  continuous  series  from  the 
heifer  of  Beaugency.  It  is  safe  to  say  that 
there  exists  very  little,  if  any,  long-human- 
ized vaccine  lymph  in  the  United  States  to- 
day, the  current  stocks  being  either  bovine 
or  virus  of  recent  removes. 

*  See  Martin,  loc.  cit.,  and  De  Wolf,  Chicago  Med.  Jour,  and 
Exam.,  May,  1881. 


CHAPTER  II. 

VARIOLA  IN  ANIMALS. 

General  Considerations. — Many  ani- 
mals, such  as  the  ox,  the  horse,  the  sheep, 
etc.,  suffer  from  contagious  eruptive  dis- 
orders, which  present  many  features  com- 
mon to  the  small-pox  of  man,  and  to  the 
variola  of  each  other ;  but  notwithstanding 
these  general  points  of  resemblance,  a  closer 
scrutiny  will  discover  features  of  radical 
difference,  both  in  their  natural  history, 
modes  of  origin  and  diffusion,  and  also  in 
their  mutual  protectiveness.  For  instance, 
while  sheep-pox  is  self-protective,  it  is  not 
antagonistic  to  human  variola,  as  is  cow-pox, 
nor  can  it  be  conveyed  by  ovination  to  other 
animals,  or  man.  Upon  the  other  hand,  the 
virus  upon  which  it  depends  is  volatile  like 
that  of  human  variola,  as  well  as  transmis- 
sible by  inoculation  ;  the  contagion  of  cow- 
pox  and  horse-pox  being  probably  trans- 
mitted only  in  the  latter  way.  Vaccinia  will 
not  protect  the  sheep  from  his  pox  nor  does 
it  produce  anything  but  a  local   effect  on 

17 


18  ESSENTIALS  OF  VACCINATION, 

that  animal,  while  it  engenders  systemic 
effects  upon  man,  the  horse,  and  the  goat. 
The  vaccine  disease  in  man  and  in  the  cow- 
is  a  strictly  local  affection,  but  in  the  horse 
it  is  apt  to  be  a  generalized  disorder."^'  In 
the  early  days  of  vaccination,  experimental 
inoculations  were  made  in  various  directions, 
in  the  hope  of  discovering  protective  viruses 
analogous  to  that  of  vaccinia.f  There  still 
remains  much  conflict  of  opinion  in  regard 
to  all  of  these  questions.  The  relationships 
of  these  various  disorders  to  each  other 
and  to  human  variola,  are  matters  of  deep 
scientific  and  practical  interest,  which,  how- 
ever, will  not  admit  of  discussion  here,  but 
will  be,  in  part  at  least,  subject  of  inquiry  in 
another  chapter. 

Natural  Cow-Pox. — Cow-pox,  the  vari- 
olic vaccinae  of  Jenner,  is  a  disease  of  the 
most  vital  interest  to  the^  human  race,  and 
worthy  of  close  study  by  the  practical  vac- 
cinator. 

Deji^iition. — Cow-pox  may  be  defined  as 
a  specific   eruptive   affection,    characterized 

*  Fleming,  Human  and  Animal  Variolse,  Lancet,  vols,  i  and 
ii,  1880. 

f  Luigi  Sacco,  Trattate  di  Vaccinazioni,  etc;  Milano, 
MDCCCIX. 


VARIOLA  IN  ANIMALS.  19 

by  a  period  of  incubation,  and  the  subse- 
quent appearance  of  lesions,  which  are  suc- 
cessively papular,  vesicular  and  pustular, 
and  normally  confined  to  the  teats  and 
udder.  It  occurs  sporadically  or  as  an  epi- 
zootic. 

Histoiy, — It  is  probable  that  the  cow-pox 
has  been  known  from  time  immemorial,  and 
it  certainly  had  been  observed  in  Europe 
before  Jenner's  day  ;  but  it  was  not  till  that 
great  man's  announcement  of  its  prophy- 
lactic power,  that  the  disease  aroused  the 
attention  of  the  world,  and  eager  search 
was  everywhere  made  for  it.  In  England 
in  the  vale  of  Aylesbury,  and  in  the  classi- 
cal vale  of  Gloucester,  it  has  been  frequently 
observed,  although  a  recent  writer^  states 
that  the  affection  has  rarely  prevailed  in  the 
first-named  place  of  late  years.  Spontaneous 
(so-called)  cow-pox  is,  so  far  as  our  knowl- 
edge goes,  a  rare  disease  in  America. 
Cases  have  been  reported,  however.f  In 
Germany,  where  in  certain  states  its  discov- 
ery was  stimulated  by  government  bounties, 

*  Newham,  Lancet,  June  4,  1881. 

f  See  De  Wolf,  loc.  cit.,  and  Martin,  Boston  Med.  and  Surg. 
Jour.,  Aug.  II,  1881. 


20  ESSENTIALS  OF  VACCINATION. 

numerous  announcements  were  made  at 
various  periods  of  its  appearance.  It  has 
been  said  that  the  much  less  frequent  occur- 
rence of  vaccinia  nowadays  is  due  to  the  fact 
that  the  milkers  who  were  fornierly  the 
active  agents  in  its  dissemination  are  no 
longer  susceptible  of  its  influence,  from  hav- 
ing undergone  vaccination.  According  to 
Dr.  Seaton,  who  was  an  ardent  advocate  of 
the  identity  of  cow-pox  with  human  variola, 
its  diminution  is  ascribed  to  the  much  less 
diffusion  of  small-pox.  Cow-pox  has  most 
frequently  manifested  itself  in  May  and  June, 
though  it  has  been  observed  by  the  late  Mr. 
Ceely  in  all  seasons,  except  midsummer.  It 
occurs  much  more  often  in  a  sporadic  way, 
and  in  solitary  instances,  than  as  an  epizootic. 
Mr.  Fleming*  ridicules  the  notion  that  milch 
cows  only  are  capable  of  contracting  the  dis- 
ease ;  he  declares  that  the  male  sex  offers  no 
bar  to  its  morbid  influence. 

Symptoms  and  Coiirse.^;  The  period  of  in- 

*  Loc.  cit. 

f  For  a  full  description  of  cow-pox  in  its  various  phases, 
the  reader  is  referred  to  the  unrivaled  papers,  beautifully  illus- 
trated, of  Robert  Ceely,  in  the  Trans.  Prov.  Med.  and  Surg. 
Ass'n,  vols,  viii  and  x.  These  rare  books  are  in  the  Surgeon 
General's  library  at  Washington.  In  Seaton's  Handbook  a 
full  account,  taken  from  Ceely,  is  also  to  be  found. 


VAEIOLA  /iV  ANIMALS.  21 

!  cubation  is  from  three  to  four  days ;  in  some 
i  cases,  from  five  to  eight.  About  four  days 
j  from  the  date  of  invasion  the  parts  become 
;  hot  and  tender,  and  small  red  papules  make 
their  appearance  on  the  part  of  the  udder 
near  the  base  of  the  teats,  and  also  on  the 
base  of  the  teats.  After  three  or  four  days 
the  papules  assume  a  vesicular  character  and 
take  on  umbilication.  A  dusky,  yellowish 
point  at  the  apex  of  the  papule  gives  the 
first  indication  of  beginning  vesiculation. 
The  vesicles  gradually  increase,  and  in  three 
or  four  days  more  attain  their  full  develop- 
ment. The  vesicles  vary  in  size  from  a  pin's 
head,  in  which  case  they  are  perhaps  the  re- 
sult of  auto-inoculation,  up  to  that  of  a  six- 
pence, or  dime;  but  more  generally  are  of 
the  dimensions  of  a  pea  or  horse-bean. 
Their  size  is  generally  determined  by  their 
number.  At  the  base  and  neck  of  the  teats 
the  vesicles  are  usually  circular,  while  on  the 
body  of  the  teats  they  are  generally  oval ; 
but  they  may  also  be  oval  on  the  udder,  and 
.  on  the  teats  they  often  run  together.  They 
have  a  metallic,  glistening  luster.  By  the 
eighth  or  ninth  day  a  pale  rose  or  light  dam- 
ask areola  appears  around  them.      Between 


22  ESSENTIALS  OF  VACCINATION. 

the  tenth  and  twelfth  days  the  disease  has 
reached  its  full  development  ;  the  areola  ex- 
tends to  a  width  of  four  or  five  lines,  and  the 
surrounding  cellular  tissue  becomes  deeply- 
infiltrated.  The  hitherto  clear  lymph  be- 
comes opaque,  and  by  the  twelfth  day,  des- 
iccation has  begun,  which  is  completed  in 
five  or  six  more  days.  The  crusts,  which 
are  of  a  brownish-black  color,  fall  off  between 
the  twentieth  and  twenty-third  days. 

These  stages  maybe  more  or  less  abridged 
or  lengthened  by  various  circumstances,  such 
as  arise  from  handling  the  parts,  or  from 
auto-inoculation,  pressure  on  the  part  of  the 
animal,  etc.  The  physical  character  of  the 
lesions  may  also  be  altered  from  the  same 
causes. 

Mr.  Ceely  has  called  attention  to  the  fact 
that  the  cow  is  subject  to  a  number  of  other 
disorders,  which  should  be  carefully  differ- 
entiated from  vaccinia.  He  enumerates  the 
following  affections  : 

"Inflammation  and  induration,  sometimes  suppuration  of  the 
cutaneous  follicles  at  the  base  of  the  teats;  small,  hard  knots, 
cutaneous  or  sub-cutaneous,  in  the  same  locality,  about  the  size 
of  a  vetch,  a  pea,  or  even  larger,  which  often  remain  indolent 
for  a  time,  at  length  become  red,  vesicate,  enlarge,  suppurate 
and  burst,  attaining  not  infrequently  the  size  of  a  walnut,  or 
more,  occasionally  affecting  the  hands  of  the  milkers,  and  often 


VAMIOLA  IN  ANIMALS.  23 

the  other  cows  milked  in  the  same  shed  by  the  same  hands;  an 
eczematous  eruption,  with  intertrigo  on  the  udder  and  near  the 
roots  of  the  teats;  warty  growths  of  two  kinds:  one  consisting 
of  long,  narrow,  pendulous  and  linear  shaped  prolongations, 
easily  removed  and  often  detached;  the  other  of  short,  thick, 
compact,  broad  elevations,  lighter  in  color,  generally,  than  the 
ground  from  which  they  rise,  of  various  sizes,  from  that  of  a 
pea  to  that  of  a  horse-bean;  frequently  very  numerous  on  the 
teats,  where  they  are  often  bleeding  and  partially  detached. 
The  yellow  pock — a  pustular  eruption  resembling  ecthyma  on 
the  teats  and  udders,  succeeded  by  thin,  dirty  brown  or  black 
irregular  crusts.  The  bluish  or  black  pock — Bluish,  or  black, 
or  livid  vesications  on  the  teats  and  udders,  followed  by  thin, 
dirty  brown  or  black  irregular  crusts  and  some  degrees  of  in- 
tertrigo on  the  interstices  near  the  bases  of  the  teats.  The 
white  pock — a  highly  contagious  disease  among  milch  cows  and 
to  the  m.ilkers,  quickly  causing  vesications  and  deep  ulcerations; 
often,  or  almost  always,  confounded  by  them  with  the  true  vac- 
cine, and  certainly  not  readily  distinguishable  in  kll  its  stages 
by  better  informed  persons  than  milkers."  Trans.  Prov.  Med. 
and  Surg.  Ass'n,  vol   viii,  p.  297. 

Finally,  as  Is  well  known,  the  vaccine  dis- 
ease may  be  induced  in  the  ox  tribe  by  in- 
oculation wdth  virus  derived  directly  from 
other  cows  laboring  under  the  natural,  casual, 
or  inoculated  form  of  the  disease ;  with  the 
virus  of  horse-pox  (equination)  ;  with  virus 
which,  originally  derived  from  the  cow  or 
horse,  has  become  humanized  by  passing 
through  the  human  system  (retro-vaccina- 
tion), or  lastly,  with  the  virus  of  human  small- 
pox (variolation). 

Horse-Pox. —  In  a  historical  and  scien- 


24  ESSENTIALS  OF  VACCINATION. 

tific  way,  horse-pox  possesses  an  interest 
next  to  that  of  vaccinia  in  the  cow.  Jenner 
was  convinced  that  vaccinia  in  the  cow  was 
always  induced  by  the  disease  known  as  the 
grease  in  the  horse.  In  his  famous  ''Enquiry'' 
he  stated  that  "in  this  dairy  country  a  great 
number  of  cows  are  kept,  and  the  office  of 
milking  is  performed  indiscriminately  by 
men  and  maid  servants.  One  of  the  former 
having  been  appointed  to  apply  dressings  to 
the  heels  of  ahorse  affected  with  the  malady 
I  have  mentioned  (grease),  and  not  paying 
the  proper  attention  to  cleanliness,  incau- 
tiously bears  his  part  in  milking  the  cows 
with  some  particles  of  the  infectious  matter 
adhering  to  his  fingers.  When  this  is  the 
case,  it  frequently  happens  that  a  disease  is 
communicated  to  the  cows,  and  from  the 
cows  to  the  dairy  maids,  which  spreads 
through  the  farm,  until  most  of  the  cattle 
and  domestics  feel  its  unpleasant  conse- 
quences. This  disease  has  obtained  the 
name  of  cow-pox."  From  the  fact  that  a  local 
affection  of  the  horse  was  confounded  with 
the  true  equine  pox,  the  result  of  experi- 
mental inoculations  proved  of  a  negative 
sort,  and  the  existence  of  horse-pox  was  de- 


VAEIOLA  IN  ANIMALS.  25 

nied.  As  early,  however,  as  1801,  Dr.  Loy, 
of  Pickering,  made  the  proper  differentiation 
between  the  two  disorders,  and  confirmed 
so  much  of  Jenner's  assertion  as  related-  to 
the  possibility  of  the  one  animal  contracting 
the  disease  from  the  other.  Viborg,  a  Dan- 
ish veterinarian,  is  said  to  have  succeeded 
also  in  producing  vaccinia  in  a  cow  with 
matter  taken  from  a  horse. 

But  it  has  been  only  in  comparatively  re- 
cent years  that  the  early  experiments  of  Loy 
and  others  have  been  confirmed ;  particu- 
larly by  the  French  physicians  and  veterina- 
rians, Pichot,  Maunoury,  Lafosse  and  Bou- 
ley.*^  While  these  various  researches  have 
abundantly  demonstrated  that  the  equine 
pox  may  produce  vaccinia  in  the  cow,  it  is 
also  apparent,  as  the  result  of  further  obser- 
vation, that  Jenner  was  wrong  in  assuming 
that  the  disease  in  the  latter  was  acquired 
in  no  other  way.  As  a  matter  of  fact,  the 
two  diseases  may  originate  quite  indepen- 
dentl)^  of  each  other  ;  cow-pox  occurs  where 
there  is  no  possible  contact  with  horses,  and 
horse-pox  where  there  is  no  nossible  means 

*  Trousseau,  Clin.  Med.,  vol.  L  'nhia,  1869. 


26  ESSENTIALS  OF  VACCINATION. 

of  contagion  from  cows.'^*  The  eruption  in 
the  horse  is  apt  to  be  generalized,  occurring 
on  the  skin  of  the  trunk  and  legs,  as  well  as 
upon  the  nasal  and  buccal  mucous  mem- 
branes. According  to  Raynaud,f  the  horse 
is  subject  to  an  eruption  similar  in  appear- 
ance to  true  horse-pox.  It  .is  more  or  less 
developed  on  the  trunk  and  limbs,  but  spar- 
ing the  mucous  membranes.  The  liquid  of 
these  vesicles  is  not  inoculable. 

Sheep-Pox. — Variola  ovina,  or  sheep- 
pox,  is  one  of  the  most  fatal  diseases  of  animal 
life ;  in  this  respect  it  differs  from  the  vario- 
Ise  of  the  horse,  ox,  etc.,  and  most  resembles 
the  variola  of  man.  The  vesicles,  however, 
are  unlike  those  of  human  small-pox,  being 
unilocular  and  without  umbilication.  Ac- 
cording to  Chauveau  its  contagion  is  very 
active,  especially  as  compared  with  that  of 
vaccinia,  infecting  with  a  hundred  times 
more  activity  th^n  the  latter. 

The  possibility  of  inoculating  the  human 
subject  with  sheep-pox  has  been  largely  de- 

*  E.  Hering,  Ueber  Kuhpocken  an  Klihen;  Stuttgart,  1839: 
and  Fleming,  loc.  cit. 

f  Recherches  e^'{;iQ|-j3  .ales  sur  I'infection  et  Timmunit^ 
vaccinales,    par/     .  ,  M.  Raynaud,    Gazette    Hebdoma- 

daire,  Nos.  29,  3\^^^^^^'9. 


\ 


VAEIOLA  IN  ANUIALS.  27 

nied,  notwithstanding  the  alleged  successes 
of  the  early  Italian  vaccinator,  Sacco.  Mr. 
Ceely  and  Mr.  Marson  made  numerous  ex- 
periments in  this  direction,  all  which  resulted 
in  failure,  except  one,  that  at  the  best  was 
regarded  as  equivocal,  and  susceptible  of 
other  explanation."^'  Korner,f  however,  re- 
ports two  cases  which  apparently  prove  that 
the  human  subject  may  be  ovinated, 
although  it  is  not  stated  that  they  thereby 
gained  vaccinal  or  variolous  immunity.  In- 
oculations of  sheep  with  the  virus  of  their 
own  pox,  produce  in  them  a  mild  form  of 
the  disease  which  procures  a  complete  im- 
munity against  further  attacks;  but  inocu- 
lations of  vaccine  lymph  or  the  lymph  of 
human  variola  give  negative  results,  the 
sheep  being  as  susceptible  as  ever  of  sheep- 
pox. 

Other  animals,  goats,  swine,  the  dog,  the 
camel,  etc.,  have  a  variola  of  their  own.  It 
is  said  that  the  disease  in  the  camel  is  com- 
municable to  man,  and  is  protective  against 

*  The  lancet  had  been  previously  employed  for  vaccination, 
f  Quoted  by  Fleming,  loc.  cit.,  p.  375.     I  would  also  refer  the 
reader  to  this  writer  for  details  of  ovination  of  other  animals. 


28  ESSENTIALS  OF  VAC  GUSTATION. 

small-pox.      Fowls    are    also    subject    to    a 
variola,  which  is  sometimes  very  fatal. "^ 

*  For  observations  on  variola  in  pigeons  see  Die  Praxis  der 
Naturgeschichte,  Dritter  Theil;  Weimar,  1882,  p.  142:  andalso 
Archiv.  Gen. -de  Med;  August,  1881,  p.  245. 


CHAPTER  III. 

NATURE  OF  VACCINIA. 

The  Relationship  of  Cow-pox  and 
Horse-pox  to  Human  Variola. — Jenner 
entertained  the  idea  that  the  grease  of  the 
horse  was  the  source  of  variola  in  the  cow 
and  in  man.  While  the  hypothesis  as  to 
the  equine  origin  of  small-pox  has  been  gen- 
erally dismissed  from  consideration,  there 
are  many  who  contend  that  cow-pox,  horse- 
pox  and  human  variola  acknowledge  one 
common  specific  infection.  Others  again 
have  declared  such  a  position  to  be  totally 
untenable.  The  most  notable  attempt 
towards  the  solution  of  these  vexed  ques- 
tions was  made  by  a  commission  appointed 
by  the  Academy  of  Sciences,  of  Lyons, 
under  the  presidency  of  M.  Chauveau. 
Briefly  stated,  the  experiments  instituted 
were  as  follows  :  The  virus  of  small-pox  was 
inoculated  on  a  number  of  animals,  horses 
and  cows,  which  was  followed  by  no  consti- 
tutional symptoms,  but  by  the  local  appear- 
ance, corresponding  to  the  site  of  puncture, 

29 


30  ESSENTIALS  OF  VACCINATION. 

of  small  red  pimples.  This  papulation  was 
more  marked  in  the  horse  than  in  the  cow. 
At  no  period  of  their  existence  did  they 
exhibit  any  tendency  to  secretion,  but  dis- 
appeared about  the  twelfth  day,  leaving  a 
small,  blackish  crust  at  the  point  of  insertion. 
With  some  serous  exudation  obtained  by 
scrapiitg  the  papules  thus  produced,  inocu- 
lations were  made  on  children,  which  resulted 
in  local  vesicles  followed  by  the  general 
eruption  of  variola.  Numerous  other  ex- 
periments were  made,  of  which  our  space 
forbids  further  detail,  all  tending  to  confirm 
the  commission  in  the  belief  that  ''small- 
pox in  its  passage  through  the  system  of  a 
cow  is  not  transformed  into  vaccinia;  it  re- 
mains small-pox,  and  returns  to  the  original 
state  of  small-pox  when  re-introduced  into 
the  human  species.''  These  views  have  been 
generally  accepted  on  the  continent  of 
Europe  in  late  years.  Mr.  Fleming  in  his 
recent  able  essay  on  "■  Human  and  Animal 
Variolae,"  adopts  the  conclusions  of  Chau- 
veau,  and  adduces  other  evidence,  such  as 
prevalence  of  cow-pox  where  human  variola 
is  unknown,  etc.,  in  support  of  his  position. 
Certain  learned  vaccinoloeists  in  our  own 


NATURE  OF  VACCINIA,  31 

country  sustain  the  theory  of  non-identity."^ 
On  the  other  hand,  many  experiments  are 
recorded,  which  in  spite  of  the  negative  re- 
sults just  quoted,  would  seem  to  conclu- 
sively demonstrate  the  identity  of  small-pox 
and  vaccinia.  In  1802,  Gassner  inoculated 
eleven  cows  with  variolous  matter,  and  suc- 
ceeded in  producing  on  one  of  them  a  char- 
acteristic vaccine  vesicle,  from  which  he 
vaccinated  four  children,  from  whom,  in  turn, 
seventeen  others  were  successfully  inocu- 
lated. 

In  1830  Dr.  Sonderland  excited  variola 
in  cows  by  enveloping  thefn  in  infected  bed- 
clothing.  In  a  few  days  the  animals  mani- 
fested the  usual  symptoms  of  cow-pox,  and 
the  vesicles  thus  produced  gave  rise  to  genu- 
ine vaccine  vesicles  when  introduced  into 
the  human  system.  In  1836  Dr.  Thiele 
succeeded  in  inducing  vaccinia  in  cows  by 
variolation.  The  lymph  thus  generated  was 
successfully  used  in  vaccination,  and  many 
subsequently  had  their  immunity  tested  by 
variolous  inoculation  and  exposure  to  small- 
pox.    But  his  further  assertion  that  he  could 

*  T.  F.   Wood,   Chicago   Med.  Jour,   and   Exam.,  October, 
1881;  N.  C.  Med.  Jour.,  February,  1882. 


32  ESSENTIALS  OF  VACCINATION, 

produce  cow-pox  without  the  intervention 
of  the  cow  at  all,  by  simply  diluting  small- 
pox vir2is  with  warm  milk,  was  received  with 
incredulity ;  and  it  is  to  be  observed  that 
Seaton  has  omitted  all  mention  of  it,  fearing 
no  doubt  to  weaken  the  cogency  of  his  argu- 
ment for  identity  by  admitting  such  an  ap- 
parently irrational  statement.  The  reader 
of  ^to-day  w^ill  readily  see  that  Thiele  was 
really,  perhaps,  anticipating  Pasteur's  re- 
searches on  the  attenuation  of  viruses.^  In 
1839  Robert  Ceely,  of  Aylesbury,  directly 
inoculated  two  storks  with  small  pox  virus, 
and  from  the  vaccine  vesicles  which  resulted, 
originated  a  stock  of  variola-vaccine  lymph 
which  was  used  on  many  children. 

But  the  most  remarkable  and  convincing 
experiments  in  this  direction  are  those  of 
Mr.  Badcock,  a  druggist,  of  Brighton. 
About  forty-five  years  ago,  having  experi- 
enced an  attack  of  post-vaccinal  small-pox, 
it  occurred  to  him  that  a  more  vigorous 
stock  of  lymph  could  be  procured  by  passing 
the  virus  of  human  variola  through  the  cow. 
Although  repeatedly  failing  afterwards,  his 
first    variolation    of  a    cow  was    successful. 

*  W.  B.  Carpenter,  Nineteenth  Century,  October,  1881,  p.  551. 


NATURE  OF  VACCINIA,  33 

From  this  inoculation  a  child  was  success- 
fully vaccinated,  and  from  this  child  others, 
and  so  on  through  a  long  series.  During 
the  course  of  twenty  years  he  attempted 
variolation  on  two  hundred  cows,  but  such 
is  the  great  difficulty  of  the  operation  that 
he  succeeded  in  producing  typical  vesicles 
on  but  thirty-three  animals.  He  found  the 
thinly  haired  skin  near  the  vulva  the  most 
favorable  point  for  inoculation.  It  is  said 
that  Mr.  Badcock  himself  has  vaccinated 
more  than  30,000  persons  with  this  lymph, 
and  that  for  more  than  forty  years  several 
hundred  practitioners  have  been  using  it 
without  causing  anything  but  typical  vaccin- 
ia from  its  employment."^ 

It  is  therefore  assumed  that  Chauveau's 
experiments  produced  nothing  but  local  pap- 
ules, and  that  when  recourse  was  had  to 
them  for  material  for  experimental  purposes, 
the  operator  merely  collected  the  same  va- 
riolous virus  that  had  been  inserted  a  few 
days  before.  The  English  experimenters 
took  lymph  from  their  variolated  cows  only 
on  the  appearance  of  vesicles,  and  rqade  no 
attempt    to    gather  serosity   from    abortive 

*  Brit.  Med.  Jour.,  November  26,  1881. 
3 


34  ESSENTIALS  OF  VACCINATION. 

papules,  which  they  regarded  merely  as  the 
result  of  local  inflammation.  It  is  quite 
possible  that  had  they  used  material  from 
such  papules,  the  same  results,  production  of 
small-pox,  would  have  occurred  to  them  as 
to  the  members  of  the  Lyons'  commission. 

There  are  several  other  points  of  view 
from  which  this  subject  may  be  considered, 
but  the  limited  space  at  disposal  precludes 
a  further  discussion.  It  seems  to  me,  how- 
ever, that  although  there  are  many  appar- 
ently conflicting  statements  yet  to  be  defi- 
nitely settled,  the  direct  positive  results 
obtained  by  Ceely  and  Badcock,  not  to 
mention  the  earlier  experimenters,  oblige 
us  to  acknowledge  that  under  certain  condi- 
tions, the  variolation  of  kine  gives  rise  to 
phenomena  possessing  all  the  specific  char- 
acters and  protective  properties  of  vaccinia. 
It  only  remains  to  add  that  the  researches  of 
Pasteur  on  the  attenuation  of  viruses  lends 
the  strongest  scientific  support  to  the  results 
of  clinical  experience.  The  time  may  even 
arrive  when  the  inoculation  of  attenuated 
variola- virus  will  supersede  altogether  the 
use  of  vaccine  lymph. 


NATUBE  OF  VACCINIA,  35 

Contagium  of  Vaccine  Virus  and 
Mode  of  Infection. — Numerous  observers 
have  demonstrated  the  existence,  in  the 
^faccine  lymph,  of  fine  molecular  bodies, 
which  are  presumed  to  be  the  vehicle  of  the 
contagion ;  others  have  regarded  them  as 
mere  chance  products.  ^ 

Bristowe  has  remarked  that  it  is  not  im- 
probable that  the  specific  poisons  of  the 
various  infectious  fevers  pass  into  the  system 
through  the  portals  of  the  lymphatic  system. f 
Recent  investigations  into  the  morbid  anat- 
omy of  hydrophobia  point  to  the  same  con- 
clusion.;); I  have  elsewhere  §  expressed  my 
belief  as  to  the  manner  in  which  the  syphil- 
itic virus  gains  access  to  the  system,  and  in 
the  same  paper  I  stated  my  conviction  that 
the  lymphatics  played  the  same  role  in  vac- 
cinia. Since  then  we  have  been  put  into 
possession  of  the  exquisite  experiments  of 

*  For  references  consult  Ziemssen's  Encyclop.  vol.  ii,  p.  381, 
Am.  edit.;  Piffard,  Dis.  of  Skin,  1876;  Proc.  Med.  Soc.  Co.  of 
Kings,  October,  1880;  and  Neumann,  Lehrbuch  der  Hauikrank- 
heiten;  Wien,  1876. 

f  Treatise  on  the  Theory  and  Practice  of  Med.,  1876. 

:[:  Jennings,  Lancet,  January  21,  1882,  p.  102. 

§  Lymphatic  Theory  of  Syphilitic  Infection,  N.  Y.  Med. 
Jour.,  December,  1877. 


36  ESSENTIALS  OF  YACCINATTON. 

Raynaud,"^  which  would  seem  to  establish 
the  fact  of  lymphatic  absorption  of  vac- 
cine virus  beyond  question.  I  am  not  aware 
that  his  positions  have  been  disputed  or 
overturned.  As  it  is  impossible  here  to  re- 
cord his  experiments  at  length,  I  have 
thought  it  advisable  to  append  his  conclu- 
sions in  a  note.f 

"  Gazette  Hebdomadaire,  No.  29,  et  seq.,  tome  xvi,  1879. 
f  Conclusions  of  M.  Raynaud's   "Experimental  Researches 
on  Vaccinal  Infection  and  Immunity": 

1.  The  vaccinal  pustule.  The  evolution  of  this  pustule  is 
not  indispensable  in  order  to  secure  immunity;  for  this  is 
secured  even,  when  after  subcutaneous  inoculation,  the  devel- 
opment of  the  pustule  is  prevented. 

2.  The  nervous  system.  A.  The  nervous  system  has  noth- 
ing whatever  to  do  with  the  evolution  of  the  phenomena  of  vac- 
cinia; the  infection  developing  itself  fully,  even  after  the 
nerves  distributed  to  the  inoculated  region  have  been  previous- 
ly divided.  B.  This  interruption  of  the  nervous  current  does 
not  even  sensibly  alter  the  gradual  evolution  of  the  pustule. 

3.  The  blood.  A.  Vaccinia  is  never  produced  by  the  subcu- 
taneous inoculation  of  vaccinal  blood;  hence  this  operation  is 
not  susceptible  of  practical  application.  B.  Transfusion  of 
large  doses  of  vaccinal  blood  is  most  always  followed  by  no 
appreciable  effects;  the  animal  still  remaining  susceptible  of 
vaccinia.  C.  Under  certain  circumstances,  however,  transfu- 
sion may  produce  vaccinal  immunity,  although  no  exterior  phe- 
nomena have  taken  place.  D.  Immunity  secured  in  this  way 
is  not  transmissible  by  a  second  transfusion.  E.  After  con- 
sideration of  the  above  facts,  there  is  very  little  probability  that 
it  is  by  means  of  the  blood  that  the  vaccinal  virus  is  generalized 
through  the  entire  economy. 

4.  The  lymphatic   vessels.     A,  The   subcutaneous   inocula- 


NATURE  OF   VACCINIA.  37 

•Whether  the  virus  of  vaccinia  is  capable 
of  passing  through  the  septum  of  the  mater- 
nal and  fcetaL  vascular  systems,  or,  in  other 
words,  whether  it  is  possible  to  render  the 
foetus  171  titero  insusceptible  of  small-pox  by 

tion  of  lymph  from  a  vaccinated  region  and  taken  from  beyond 
the  nearest  ganglion,  has  met  with  the  same  negative  results  as 
the  hypodermic  inoculation  of  vaccinal  blood.  B.  On  the  other 
side,^  I  produced  horse-pox,  by  injecting  into  the  blood  of  a 
horse  a  few  grammes  of  this  lymph.  C.  Hence  this  lymph 
may  be  virulent,  provided  it  be  used  in  rather  large  doses. 

5.  The  lymphatic  ganglions.  A.  A  fact  until  now  over- 
looked is  that  in  a  normal  vaccination  there  is  always  engorge- 
ment of  the  nearest  ganglion,  which  deserves  the  name  of  vac- 
cinal bubo.  This  bubo  is  indolent  and  without  inflammatory 
reaction.  B.  The  inoculation  of  the  juice  obtained  from  this 
ganglion,  at  whatever  time  it  may  be  taken,  never  produces 
vaccinia.  C.  It  is  possible  then,  that  traces  of  virulence  be 
found  in  the  lymphatic  system  between  the  inoculated  region 
and  the  nearest  ganglion.  From  the  (^A parti r  de)  %2,vi^\ovy  on. 
no  trace  of  virulence  can  be  detected.  D.  This  fact  is  of  such 
a  nature  as  to  cause  us  to  look  upon  the  ganglions  as  being  en- 
dowed with  an  elaborating  power  in  regard  to  the  disappear- 
ance of  the  virulence  and  the  appearance  of  immunity.  These 
phenomena  are  simultaneous  and  correlative.  E.  The  experi- 
ments giving  this  hypothesis  a  high  degree  of  plausibility,  are 
those  which  enabled  me  to  dissociate  the  absorption  of  virus 
and  vaccinal  infection.  The  one  is  not  the  necessary  conse- 
quence of  the  other.  This  dissociation  has  been  obtained  by 
the  experimental  suppression  of  ganglionic  intervention,  either 
by  extirpating  the  ganglions  under  certain  determined  condi- 
tions, or  by  causing  the  virus  to  enter  a  lymphoid  organ  having 
no  connection  with  the  ganglions,  e.g.,  the  anterior  chamber 
of  the  eye.  F.  The  immunity  obtained  by  the  injection  of  the 
virus  directly  into  the  veins  does  not  prove  against  this  elabo- 


38  ESSENTIALS  OF  VACCINATION. 

vaccinating  the  pregnant  mother,  is  a  ques- 
tion which  has  not  yet  received  a  definite 
answer.  Therefore  I  shall  not  enter  upon 
its  discussion  here."^' 

rating  role  of  the  ganglions,  for  being  vascular  organs  they  are 
constantly  bathed  in  blood.  G.  It  is  certain,  that  the  vaccine 
virus  inoculated  into  the  skin  loses  its  inoculability  in  passing 
thi'ough  the  nearest  lymphatic  ganglions,  thus  establishing  be- 
tween it  and  the  inoculable  material  of  charbon  a  fundamental 
difference,  which  is  very  important  with  reference  to  the  gen- 
eral theory  of  viruses. 

"  The  experim.cnts  bearing  upon  this  question  are  very  con- 
tradictory. In  the  first  place,  Bollinger  (Sammlung.  Klin. 
Vortr.,  No.  ii6)  suggested,  as  the  poison  of  small-pox  was 
known  to  be  capable  of  transmission  from  the  mother  to  the 
foetus,  a  similar  condition  might  exist  in  regard  to  vaccinia, 
and  that  the  frequent  insusceptibility  of  infants  of  vaccinia 
might  be  due  to  the  revaccination  of  their  mothers  during  preg- 
nancy. The  results  of  some  experiments  on  sheep  pointed  in 
the  same  direction.  Rickett  inoculated  about  700  pregnant 
ewes  during  the  last  four  to  six  weeks  Vv* ith  variola  ovina.  Their 
lambs  were  inoculated  when  from  four  to  six  weeks  old  with 
good  sheep-pox  virus;  no  result  followed  in  any  case,  while 
thirty-six  other  lambs  treated  in  the  same  way  had  fine  pus- 
tules. Induced  by  these  considerations,  Burckhardt  (Deutsches 
Arch.  f.  Klin.  Med.  Band  xxiv)  made  some  experiments  on  the 
pregnant  human  female.  He  vaccinated  twenty-eight  pregnant 
women,  but,  owing  to  circumstances,  only  eight  of  the  children 
born  to  these  women  could  be  employed  for  experimentation. 
Four  children  were  vaccinated  whose  mothers  had  not  been  in- 
oculated during  pregnancy,  and  in  every  case  with  successful 
result.  With  this  same  lymph  he  vaccinated  the  eight  children 
of  the  revaccinated  mothers.  The  results  were:  The  children 
of  four  women,  whose  revaccination  had  been  successful  dur- 
ing pregnancy,  were  found  to  be  insusceptible.  The  children 
of  two  of  the  women,  whose  revaccination  during  pregnancy 


NATURE  OF  VACCINIA,  39" 

had  been  only  partially  successful,  were  also  found  to  be  insus- 
ceptible. Of  the  two  children  whose  mothers  had  been  unsuc- 
cessfully vaccinated,  one  was  vaccinated  successfully,  and  the 
other  failed.  Cast's  researches  (Bed.  Klin.  Woch.  No.  5,  1880) 
gave  quite  different  results.  He  inoculated  pregnant  women 
in  the  seventh,  eighth,  and  last  months  of  gestation,  the  latest 
about  ten  days  before  confinement.  These  re  vaccinations  were 
partly  normal,  partly  modified,  and  partly  negative.  The  chil- 
dren of  these  women  were  afterward  vaccinated  with  the  result 
of  producing  typical  results  in  all,  whether  the  mothers  had 
been  successfully  inoculated  or  not.  It  is  stated  that  very 
young  infants  are  much  more  difficult  to  vaccinate  than  older 
children,  which,  together  with  bad  lymph  and  faulty  technique, 
would  account  for  the  failures.  Pasteur's  latest  researches  also 
bear  on  this  point.  A  lamb,  the  offspring  of  a  sheep  that  had 
been  "  protected"  by  charbon  vaccination,  when  inoculated 
with  the  same  virus,  expired  within  twenty-four  hours  (Med. 
Times  and  Gaz.,  February  4,  1882).  Finally,  Bollinger's  anal- 
ogy drawn  from  the  fact  that  variola  in  the  mother  is  capable  of 
transmission  to  the  foetus,  also,  perhaps,  admits  of  another  ex- 
planation; for  it  is  not  absolutely  certain  that  the  foetus  is  in- 
fected through  the  mother's  blood  (Ziemmsen's  Encyclop.,  vol. 
ii,  p.  327).  Kassowitz's  studies  on  hereditary  syphilis  are  not 
without  interest  in  this  connection. 


CHAPTER  IV. 

VACCINIA  IN  THE  HUMAN  SUBJECT. 

Symptoms  and  Course. — Vaccinia  is 
never  acquired  by  the  human  subject, 
except  as  the  result  of  inoculation. 

Usually*at  the  close  of  the  third  day  af- 
ter the  inoculation  of  vaccinia  upon  a  pre- 
viously unvaccinated  subject,  a  slight  eleva- 
tion of  the  skin  may  be  felt  or  seen  at  the 
site  of  operation.  On  the  fourth  day  papu- 
lation is  well  marked.  On  the  fifth  day  ves- 
iculation  has  commenced,  and  by  the  sixth 
day,  a  distinct  vesicle  has  been  developed, 
cellular  in  structure,'^*  of  a  bluish-white  color, 
and  presenting  a  characteristic  raised  edge 
and  a  central  cup-like  depression.  This 
vesicle  gradually  enlarges,  and  on  the 
eighth  day  attains  its  greatest  perfection. 
At  this  date,  a  few  hours  earlier  or  later,  a 
specific  inflammation  of  the  skin,  called  the 
areola,  forms  about  the  base  of  the  vesicle, 
and  the  vesicle  and  areola  continue  to  in- 

*  The  structure  of  the  successive  vaccinal  lesions  is  the  same 
as  in  variola. 

40 


VACCINIA  IN  THE  HUMAN  SUBJECT,       41 

crease  for  the  next  two  days.  The  areola, 
which  was  but  a  few  lines  in  width  at  first, 
enlarges  to  the  dimensions  of  two  inches  or 
more,  and  is  of  a  deep  red  color,  and  hot 
and  tender  to  the  touch,  and  accompanied 
by  swelling  and  induration  of  the  subjacent 
cellular  tissue.  On  the  tenth  day,  when  the 
inflammation  has  reached  its  acme,  local  dis- 
turbance, heat,  itching  and  tenderness  are 
marked,  and  more  or  less  febrile  reaction, 
occasionally  out  of  proportion  to  the  local 
dermatitis,  is  manifest.  Sometimes  the  con- 
tiguous lymphatic  glands  are  obviously  en- 
larged and  sensitive."^* 

After  the  tenth  or  eleventh  day  the  pus- 
tule, for  such  it  has  become,  begins  to  dry 
in  the  center,  the  areola  grows  narrower, 
and  gradually  disappears,  and  the  swelling 
and  induration  of  the  tissues  materially 
abates.  Desiccation  of  the  pustule  steadily 
progresses,  and  by  the  fourteenth  or  fif- 
teenth day  a  dark  mahogany-colored  scab 
has  formed,  which  falls  off  between  the  sev- 

*  Raynaud  (loc.  cit  )  states  that  there  is  constantly  found  in 
young  children,  from  the  fifth  to  the  seventh  day  after  vaccina- 
tion, indolent,  pea-sized  glands,  which  roll  under  the  finger, 
and  can  always  be  detected.  They  are  to  be  looked  upon  as 
indicating  the  specific  infection  of  the  system. 


42  ESSENTIALS  OF  VACCINATION. 

enteenth  and  twenty-fifth  days.  The  sepa- 
ration of  the  crust  reveals  a  cicatrix,  which  is 
vascular  at  first,  but  finally  assumes  a  dead- 
white  color.  This  scar  is  generally  circular, 
depressed,  and  marked  with  minute  pits,  and 
occasionally  radiated. 

Mr.  (now  Sir)  E.  Wilson  recapitulates 
thus :  First  two  or  three  days,  znctcoaiton  ; 
fourth  day,  papular;  fifth  to  eighth, 
vesicular  (umbilication)  ;  eighth  day,  areola; 
ninth  to  eleventh  days,  pustular,  umbilica- 
tion lost,  areola  enlarged ;  fifteenth  to  seven- 
eenth  days,  period  of  separation.  The  phe- 
nomena of  successful  vaccination,  as  de- 
scribed by  different  observers,  suffer  certain 
slight  deviations  from  the  course  here  por- 
trayed. This  is  undoubtedly  due  to  the 
variations  in  the  quality  and  vigor  of  the 
lymph  employed,  to  the  condition  of  health, 
of  the  person  vaccinated,  the  state  of  the 
weather,  season  of  the  year,  mechanical  in- 
terference, etc. 

Normal  Deviations. — Although  in  no 
way  a  deviation  from  the  normal  course  of 
vaccinia,  it  should  not  be  forgotten  that  the 
lesions  will  differ  in  appearance  according  to 
the  method  of  performing  the  inoculation. 


VACCINIA  IN  THE  HU3IAN  SUBJECT.       43 

When  vaccination  is  done  by  scarification  or 
somewhat  extensive  abrasion,  several  vesi- 
cles may  be  developed,  producing  a  com- 
pound vesicle,  followed  by  an  irregular  cica- 
trix. A  small  straw-colored  scab  is  also 
sometimes  seen  over  the  center  of  a  vesicle 
which  contains  none  of  the  virus,  when  the 
method  of  scarification  has  been  followed. 
(J.  Lewis  Smith.) 

According  to  Dr.  F.  P.  Foster,  if  the 
pock  have  been  produced  by  long  human- 
ized virus,  it  will  reach  its  acme  by  the 
eighth  day;  but  if  bovine  virus  have  been 
employed,  the  vesicle  will  go  on  increasing 
in  size  for  several  days  longer. 

Retardation  in  the  course  of  a  vaccina- 
tion is  not  an  uncommon  occurrence.  The 
vesicle  may  be  delayed  a  day  or  two  in 
its  progress  ;  an  eight  day  vesicle  may  be  no 
larger  than  is  one  ordinarily  on  the  sixth^ 
and  the  areola  may  be  delayed  to  the  tenth 
day  or  later. 

A  relatively  long  period  of  incicbation  is 
frequently  observed.  This  fact  I  have  been 
particularly  struck  w^ith  after  the  use  of  dry 
bovine  virus.  My  friend,  Prof.  I.  E.  Atkin- 
son, of  Baltimore,  informs  me  that  he  has  no- 


44  ESSENTIALS  OF  VACCINATION. 

ticed  the  stage  of  papulation  to  be  post- 
poned from  five  days  to  a  week.  Afterward, 
however,  the  disease  runs  a  normal  course. 

Seaton  has  ascribed  this  delay  to  the  use 
of  dry  lymph,  which  after  being  put  in  the 
skin  simply  waited  solution  to  be  absorbed. 
This  explanation  is  undoubtedly  correct, 
and  if  it  hold  good  for  humanized  lymph, 
such  as  was  used  by  Seaton,  it  is  doubly 
true  of  bovine  albumen,  which  is  far  more 
insoluble. 

The  constitutional  symptoms  are  some- 
times very  slight.  The  febrile  reaction,  the 
test  of  systemic  infection,  differs  in  differ- 
ent subjects,  and  is  undoubtedly  more  or 
less  intense  according  to  the  activity  of  the 
lymph  employed.  The  contiguous  lymphat- 
ic glands  are  sometimes  much  enlarged ;  but 
suppuration  is  rare,  and  when  it  occurs  is 
apt  to  be  due  to  the  natural  or  acquired  un- 
favorable condition  of  the  patient. 

Bryce's  Test — If  vaccine  virus  be  rein- 
oculated  on  the  fourth,  fifth  or  sixth  day 
after  a  primary  vaccination,  the  vesicles  of 
the  second  insertion  are  hurried  forward  so 
as  to  overtake  the  first  crop,  and  the  whole 
come    to    maturity    together.     The    second 


VACCINIA   IN  THE  HU3IAN  SUBJECT.       45 


crop  are  not  more  than  one-fourth  the  nor- 
mal size,  and  the  areola  surrounding  them  is 
likewise  much  diminished.  If  no  accelera- 
tion of  the  secondary  vesicles  be  observed, 
it  is  to  be  considered  that  the  first  vaccina- 
tion failed  to  infect  the  system.  The  second 
is  then  to  be  looked  upon  as  the  primary  af- 
fection, which  in  turn  should  be  tested  by  a 
third,  and  so  on.  The  practical  carrying 
out  of  this  procedure  would  be  a  matter  of 
great  difficulty,  even  if  the  theoretical  de- 
ductions to  be  drawn  from  it  did  not  admit 
of  question. 

Vaccinia  after    Small-Pox. —  It  has 

sometimes  been  observed  that  vaccinia,  more 
or  less  normal  in  its  course,  will  occur  after 
small-pox.  I  have  noticed  this  quite  a  num- 
ber of  times  in  persons  who  had  undergone 
variolous  inoculation  in  their  youth.  Re- 
cently, I  saw  quite  a  characteristic  revacci- 
nation  result  in  a  medical  man,  who  had  suf- 
fered small-pox  in  Vienna,  in  1876.  The 
literature  of  vaccination  will  afford  numerous 
instances  of  such  an  occurrence.  It  is  to  be 
observed,   however,  that  the  small-pox  has 


46  ESSENTIALS  OF  VACCINATION, 


been  experienced,  in  most  cases,  many  years 
before."^ 

Vaccinia  Revived. — Some  curious  iur 
stances  of  the  revival  of  dormant  vacci^ 
nations  have  been  reported.  Mr.  Shep- 
herd (Lancet,  June,  1881,  p.  978),  records 
the  case  of  a  nurse  whom  he  vaccinated  on 
the  right  arm  unsuccessfully  in  four  places^ 
four  years  before.  Lately  he  again  vacci- 
nated her  on  the  left  arm  in  four  places,  pro- 
ducing one  well-marked  vaccine  pustule.  In 
a  few  days  the  four  places  on  the  right  arm 
threw  out  distinct  areolae,  and  show^ed  tolera- 
bly characteristic  marks  of  successful  revacci- 
nation.f  A  case  is  mentioned  by  Sir  Thos. 
Watson  of  a  little  girl  who  w^as  vaccinated  in 
infancy,  and  in  whom  the  spots  became  well 
developed  pustules  during  an  attack  of  influ- 
enza, fourteen  years  afterward.  Mr.  Byerly 
relates  an  instance  where  the  virus  remained 
dormant  for  two  months  before  taking. 
Other  instances  have  been  published. 

Insusceptibility  of  Vaccinia. — Itmust 
be  admitted,  both  from  analogy  and  actual 

*  For  cases  and  references  see  New  York  Med.  Record,  July 
5  and  26,  1879. 

f  London  Med.  Rec,  July  15,  i88i. 


VACCINIA   m  THE  HUMAN  SUBJECT.       47 


experience,  that  some  persons,  at  one  time 
or  another,  are  insusceptible  of  vaccinia  ;  but 
this  condition  of  system  must  be  exceedingly- 
rare.  Inefficiency  in  the  operation  of  vacci- 
nation, or  some  fault  in  the  quality  of  the 
lymph  employed,  generally  lies  at  the  bottom 
of  such  inaptitude. 


CHAPTER  V. 

ABNORMAL    MODIFICATIONS  AND  COMPLI- 
CATIONS OF  VACCINIA. 

Spurious  Vaccinia  — It  has  been  seen 
that  a  vaccination  may  be  regarded  as  run- 
ning a  normal  course,  although  in  some  of 
its  stages  more  or  less  retardation,  or  slight 
acceleration,  may  occur;  but  in  other  in- 
stances the  departure  from  the  customary 
phenomena  of  the  eruption  is  widely  marked. 
Now,  while  some  of  these  forms  of  irregular 
vaccinia  are  perhaps  protective — for  small- 
pox is  nevertheless  small-pox  in  spite  of  per- 
fectly analogous  local  modifications — -it  is  an 
eminently  safe  rule  to  assume  that  the  vac- 
cination has  been  ineffectual  unless  it  has 
developed  a  characteristic  vesicle  and  well- 
formed  areola,  running  a  fairly  typical  course. 
Any  doubt  as  to  the  genuineness  of  a  vac- 
cinal result  should  always  be  put  to  the  test 
of  a  revaccination. 

A  so-called  spurious  vaccinia  may  take 
on  one  of  the  following  aspects :  i.  Red 
tubercles,    the  size   of   peas,  appear  at  the 

48 


MODIFICATIONS,  ETC.,  OF  VACCINIA.       49 

seat  of  vaccination.  These  tubercles  after- 
ward suppurate.  Hebra  says  they  corre- 
spond to  ordinary  folHcular  furunculi.  The 
prevalent  notion  that  these  tubercles  ap- 
pear only  after  the  use  of  bovine  virus,  is 
incorrect,  for  this  irregularity  was  observed 
years  before  the  introduction  of  animal 
vaccination.  2.  In  other  instances  the  vesi- 
cle commences  with  much  itching  and  irri- 
tation ;  it  is  not  umbilicated,  but  acumi- 
nated or  conbidal,  and  contains  straw-col- 
ored, or  opaque,  instead  of  clear  lymph; 
the  areola  is  completed  by  the  fifth  or  sixth 
day,  and  begins  to  decline  on  the  eighth  day, 
the  scab  falling  off  by  the  tenth  day.  3.  In- 
stead of  the  usual  papule  or  vesicle,  a  bulla 
containing  a  transparent  fluid  and  having  a 
reddened  margin,  may  develop.  Trouble- 
some ulceration  sometimes  arises  beneath 
the  crusts,  which  are  formed  after  the  rup- 
ture of  the  blebs.  4.  A  crop  of  herpetic  ves- 
icles, preceded  by  shivering,  may  appear 
about  the  third  day  after  vaccination.  These 
soon  burst,  and  the  exuded  fluid  gives  rise 
to  an  eczematous  eruption,  the  skin  becom- 
ing hard  and  cedematous.  Intolerable  itch- 
ing accompanies  the    vesicles,  and  the  ax- 


50  ESSENTIALS  OF  VACCINATION, 

illary  glands  become  enlarged.  5.  Occasion- 
ally, vesicles  which  have  apparently  run  a 
normal  course  up  to  the  eighth  or  tenth  day, 
suddenly  rupture,  and  ulcers,  that  spread 
both  superficially  and  deeply,  make  their  ap- 
pearance. They  cause  pain  or  itching,  and 
are  accompanied  by  much  constitutional  dis- 
turbance. 

Erysipelas  after  Vaccination. — Ery- 
sipelas is  a  comparatively  rare,  although  one 
of  the  most  serious  complications  of  vacci- 
nia or  rather  of  vaccination.  Dr.  Ballard 
makes  a  wise  distinction  between  erysipelas 
after  vaccination  and  erysipelas /r^;^^  vacci- 
nation. He  points  out  that  the  disease  may 
occur  as  a  consequence  of  the  prevalence  of 
general  erysipelas,  or  may  be  due  to  sanitary 
defects  in  the  house  of  the  patient.  Dr.  J. 
Lewis  Smith"^  observes  that  the  vaccination 
acts  often  merely  as  an  exciting  cause,  not 
from  any  deleterious  property  in  the  virus 
itself,  but  just  as  an  equal  degree  of  inflam- 
mation might  be  produced  from  a  cut,  burn 
or  other  indifferent  agency.  On  the  other 
hand,  the  virus  itself  may  be  the  direct  ex- 
citing cause.     Vaccinal  erysipelas  may  com- 

*  Dis.  of  Children. 


MODIFICATIONS,  ETC.,  OF    VACCINIA.        51 

mence  immediately  after  the  operation,  or  it 
may  wait  upon  the  development  of  the  vesi- 
cle, or  be  delayed  until  the  fall  of  the  crust. 
Its  symptoms  and  course  require  no  particu- 
lar description. 

Excluding  those  cases  of  erysipelas  in 
which  the  vaccination  has  been  merely  an 
accidental  factor,  it  is  stated  that  the  disease 
is  prone  to  occur  from  use  of  revaccination 
lymph,  from  spurious  primary  cases,  or  from 
lymph  taken  at  too  late  a  period  of  the  vesi- 
cle, or  finally  from  lymph  which  has  become 
partially  decomposed.  It  should  not  be  for- 
gotten that  erysipelas  after  vaccination  is 
of  exceedingly  rare  occurrence,  much  rarer 
than  after  small-pox  in  former  days. 

Influence  of  Mechanical  Interfer- 
ence.— The  course  of  the  vaccine  vesicle  is 
sometimes  interfered  with  by  mechanical  in- 
fluences, such  as  scratching,  rubbing  of  the 
clothes,  etc.  The  inflammation  under  these 
circumstances  is  apt  to  be  increased,  and  sup- 
puration may  occur.  The  scab  which  results 
is  composed  of  large  yellowish  crusts  unfit 
for  use  in  vaccination.  It  is  quite  possible 
that  in  this  case  the  protective  influence  of 
the  disease  is  not  decreased,  but  a  safe  prac- 


52  ESSENTIALS  OF  VACCINATION. 

tice  would  be  to  revaccinate  after  such  an 
untoward  event. 

Glandular  Involvements,  etc. — In- 
flammation and  suppuration  of  contiguous 
lymphatic  glands  are  sometimes  an  annoy- 
ing, although  not  generally  a  serious  com- 
plication. Hebra"^'  states  that  occasionally 
swelling  of  the  parotid  and  submaxillary 
glands  occurs  after  vaccination,  attended 
with  rather  abundant  salivation.  In  child- 
ren of  a  vitiated  constitution,  when  the  in- 
flammation surrounding  the  vesicle  has  been 
intense,  circumscribed  abscesses  may  occur. 
Mr.  Savoryf  reports  a  case  of  pyaemia  fol- 
lowing about  the  ninth  day  after  vaccination, 
which  resulted  in  death.  Dr.  DayJ  records 
the  case  of  a  patient  who  had  wasting  of  the 
deltoid,  and  paralysis  of  the  arm,  which  he 
regarded  as  consequent  upon  vaccination. 

Otitis  Media  Suppurativa  after  Vac- 
cination.— My  friend  Prof  H.  N.  Spencer, 
the  distinguished  otologist,  of  this  city,  has 
given  me  the  notes  of  six  cases  of  suppurative 
ear  trouble,  which  were  apparently  the  result 

*  Dis.  of  Skin,  New  Sydenham  Soc,  vol.  i,  r866. 

f  St.  Bartholomew's  Hosp.  Rep.,  vol.  xv,  p.  263,  1879. 

X  Dis.  of  Children;   Phila.  iSSi,  p.  98. 


MODIFICATIONS,  ETC.,  OF  VACCINIA.        53 

of  vaccination.  These  cases  occurred  this 
winter  during  the  general  vaccination  and 
revaccination,  in  persons  who  had  never  suf- 
fered before  from  any  similar  disorder.  The 
affection  was  of  a  violent  character,  just  as 
in  scarlet  fever,  etc.,  and  made  its  appear- 
ance in  one  case  three  days  after  vaccina- 
tion, in  three  cases  on  the  tenth  day,  and  in 
two  cases  between  the  tenth  and  fifteenth 
days  (exact  date  unknown).  The  persons 
affected  were  all  adults,  and  had  been  the 
subjects  of  revaccination. 

Vaccinal  Eruptions. — It  is  an  old  ob- 
servation that  certain  acule  eruptive  disor- 
ders sometimes  occur  in  the  course  of  a  vac- 
cinia. I  quite  agree  with  Behrend*  that  they 
do  not  owe  their  existence  to  any  specific 
action  of  the  vaccine  virus,  but  that  they 
are  perfectly  analogous  to  the  exanthe- 
mata following  the  internal  administration 
of  drugs :  in  neither  case  possessing  any 
constancy  of  expression,  but  differing  in 
different  individuals.  As  these  cutaneous 
manifestations  may  occur  at  any  period  be- 
tween the  operation  of  vaccination  almost 
to  the  date  of  separation  of  the  crust,  I  ap- 

*  Arch.  Derm.,  October,  1881. 


54  ESSENTIALS  OF  VACCINATION. 


prehend  that  they  are  excited  by  one  of 
several  causes :  First,  the  irritation  of  the 
skin  caused  by  the  act  of  vaccinating.  Second, 
the  presence  of  vaccine  virus  circulating  in 
the  blood.  Third,  the  direct  absorption  of 
septic  material  during  the  period  of  suppu- 
ration. As  in  medicinal  rashes,  we  must 
acknov^ledge  an  individual  idiosyncrasy  in 
their  production.  According  to  my  own 
observation  these  vaccinal  eruptions  have 
almost  invariably  appeared  after  the  ninth 
day  of  vaccination.  As  regards  the  roseola 
vaccinia,  Hebra  places  it  between  the  third 
and  eio^hteenth  dav.  Behrend  makes  two 
distinct  periods  for  vaccinal  eruptions,  of 
which  the  first  begins  on  the  second  day  at 
the  latest,  and  the  second  on  the  eighth 
day.  The  most  common  eruption  met  with 
is  roseola,  which  first  shows  itself  near  the 
point  of  vaccination,  thence  gradually 
spreading  over  a  large  extent  of  surface 
(Hebra)  or  occurring  as  a  macular  exan- 
them  appearing  evenly  distributed  over  the 
body,  imperfectly  distributed  on  the  extremi- 
ties and  entirely  sparing  the  face  (Behrend). 
A  minute  description  of  the  various  vac- 
cinal eruptions,  although  of  great  interest 


MODIFICATIONS,  ETC.,  OF   VACCINIA,        55 

to  the  dermatologist,  would  be  out  of  place 
here.  Therefore,  it  will  suffice  to  say  that 
bullous  and  vesicular  eruptions,  urticaria, 
and  the  eruption  of  erythema  multiforme 
have  been  recorded.  I  have  been  particu- 
larly struck  with  the  prevalence  of  erythema 
multiforme  during  the  past  winter,  which  was 
undoubtedly  consequent  upon  vaccination. 
I  have  notes  of  several  cases  of  ecthyma 
and  one  of  herpes  zoster,  occurring  several 
weeks  after  the  fall  of  the  scab,  directly 
over  and  about  the  vaccinated  region. 
Ceely  and  Gregory  have  seen  vaccinia  at- 
tended with  purpura. 

These  manifestations  are  all  benign  in 
character,  and  always  end  in  complete  re- 
covery ;  but  a  cutaneous  complication  of  con- 
siderable more  gravity  is  described  by 
Hutchinson'^  and  Stokes,f  under  the  name 
of  vaccinia  gangrsenosa.  In  Mr.  Hutchin- 
son's case,  the  child  from  whose  arm  the 
lymph  was  taken  was  apparently  healthy, 
and  three  other  children  vaccinated  from 
the  same  source  showed  no  unusual  symp- 
toms.    On  the  eighth  day  the  vaccinated 

*  British  Med.  Jour.,  December  13,  1879. 
t  Dublin  Med.  Jour.,  June  i,  1880. 


56  ESSENTIALS  OF  VACCINATION, 

spots  had  risen,  as  usual,  but  the  child's  body 
presented  an  eruption,  which  was  first  mis- 
taken for  variola.  Three  days  later  the  vesi- 
cles of  the  eruption  were  surrounded  by 
large  red  areolae  which  developed  into  gan- 
grenous patches.  The  child  died  three  weeks 
after  vaccination.  The  vaccination  scars 
were  normal.  In  Mr.  Stokes'  case,  purple 
and  black  spots  appeared  within  forty-eight 
hours  after  vaccination,  which  subsequently 
became  gangrenous.  The  vaccine  vesicles 
ran  a  normal  course.     The  child  recovered. 

Eczema  after  Vaccination. — In  ecze- 
matous  subjects  the  operation  of  vaccination 
is  apt  not  only  to  aggravate  an  existing  erup- 
tion, but  also  to  arouse  a  latent  predisposi- 
tion to  the  disease.  In  these  cases,  however, 
the  vaccination  acts  merely  as  an  exciting 
agent,  just  as  eczema  is  often  produced  in 
those  predisposed  to  it  by  piercing  the  ears 
for  ear-rings,  etc.  Most  of  the  instances  of 
so-called  scrofula  after  vaccination  are  merely 
examples  of  eczema  thus  aroused.* 

Generalized  Vaccinia. —  So-called  su- 

*  Mr.  Tait  has  reported,  on  the  other  hand,  cases  of  long 
standing  eczema  in  children,  where  the  vaccination  apparently 
provoked  rapid  cures. 


MODIFICATIONS,  ETC.,  OF  VACCINIA.       57 

pernumerary  vesicles,  which  are  the  result  of 
accidental  inoculation  during  the  operation 
of  vaccination,  or  from  the  subsequent  trans- 
fer of  lymph  to  abraded  surfaces,  are  not  un- 
common. The  existence,  however,  of  true 
eruptive  vesicles,  the  "vaccine  generalisee" 
of  the  French,  admits  of  serious  question. 
Vaccinators  of  very  large  experience  have 
never  seen  such  an  occurrence.  Doubtless 
the  significance  of  certain  accidental  vesicu- 
lar eruptions  has  been  misinterpreted.  Of 
course,  the  true  test  would  be  their  capacity, 
upon  inoculation,  of  producing  normal  vac- 
cine vesicles.  Ceely  remarks  that  it  is  rare 
to  see  them  upon  parts  to  which  lymph 
might  not  have  been  directly  applied.  He 
further  states  that  it  is  not  absolutely  neces- 
sary that  the  skin  should  have  been  visibly 
abraded.  It  is  but  just  to  observe  that  M. 
Hardy,  the  distinguished  dermatologist,  is 
reported  as  saying  at  the  recent  Medical 
Congress,  that  generalized  vaccinia  is  com- 
mon. I  have  seen  cases  that  were  supposed 
to  be  instances  of  true  eruptive  vesicles,  that 
a  careful  examination  proved  to  be  merely 
the  result  of  auto-inoculation. 

Vaccinal  Syphilis. — Numerous  instan- 


58  ESSENTIALS  OF  VACCINATION, 

ces  of  the  transmission  of  syphilis  by  the 
operation  of  vaccination  are  recorded.  Vi- 
ennois"^  is  of  the  opinion  that  it  is  the  blood 
drawn  in  collecting  the  lymph  which  is  re- 
sponsible for  the  contagion  and  not  the 
lymph  itself.f  According  to  Keyesij;  vaccin- 
al syphilis  yields  the  most  convincing  proof 
that  heterologous  diseases  upon  a  syphilitic 
person  do  not  contain  the  poison  in  their  se- 
cretions. Inherited  syphilis  sometimes  de- 
velops after  vaccination,  the  operation  mere- 
ly hastening  into  activity  the  latent  trouble. 
Again  the  vaccination  may  not  possess  even 
this  causal  relation,  the  syphilis  being  upon 
the  point  of  outbreak  at  the  time  of  the  vac- 
cine inoculation.§     The  appearance  of  the 

*  Arch.  Gen.  de  Med.,  June,  i860  (quoted  by  Bumstead  & 
Taylor). 

f  This  fact  is  supported  by  the  statement  of  Willan  that  the 
variolous  pustule  may  be  developed  within  the  margin  of  the 
vaccine  vesicle,  and  matter  taken  from  it  produce  small-pox, 
while  fluid  taken  from  the  opposite  edge  of  the  vesicle  com- 
municates cow-pox.  (Vaccine  Inoculation,  p.  6,  Note,  quoted 
by  Seaton). 

X  The  Venereal  Diseases;  N.  Y.,  1880. 

§  An  instance  is  recorded,  where  for  some  reason  a  proposed 
vaccination  was  postponed;  in  the  interval  the  infant  developed 
an  inherited  syphilis.  In  this  case,  as  in  all  other  troubles  that 
happen  to  appear  after  vaccination,  the  parents  would  have 
been  only  too  happy  to  have  availed  themselves  of  a  convenient 
scape-goat  for  their  own  infirmities. 


MODIFICATIONS,  ETC.,  OF  VACCINIA.        59 


constitutional  symptoms  of  syphilis  within  a 
few  days  or  weeks  after  vaccination  would 
render  it  probable  that  the  disease  was 
already  latent  in  the  system,  the  period  of 
syphilitic  incubation  being  considerably 
greater.  Mr.  Hutchinson,  while  admitting 
that  the  pure  lymph  of  a  vaccine  vesicle  is 
perhaps  never  the  vehicle  of  contagion, 
thinks  that  it  is  sufficient  to  let  the  vesicle 
draw  or  weep,  in  order  to  engage  in  the  se- 
cretions corpuscular  elements  of  the  blood, 
and  tissues."^*  Where  the  vaccine  crust  is 
used,  which  always  contains  a  portion  of 
the  true  skin,  the  only  guarantee  for  safety 
would  be  in  the  condition  of  the  child  from 
whom  it  was  taken.  Even  with  our  present 
facilities  for  obtaining  virus  direct  from  the 
calf,  it  should  not  be  forgotten  that  syphilis 
may  be  conveyed  by  using  an  infected  in- 
strument. 

My    friend,    Dr.    Robt.   W.    Taylor,t    of 
New  York,  has  pointed  out  in  a  very  forci- 

*  It  is  still  believed  by  some  that,  in  these  cases,  the  blood  is 
not  the  only  vehicle  of  contagion,  and  that  epidermic  scales,  or 
leucocytes,  or  the  secretions  of  an  ulcer  underlying  the  vaccine 
vesicle  (Reinecker)  noay  also  be  responsible.  Bumstead  & 
Taylor,  Venereal  Diseases,  1879  p.  433. 

f  Arch.  Dermatol.,  vol.  ii,  1876  ;  and  Bumstead  &  Taylor,  loc. 
cit.,  p.  4'^4. 


60  ESSENTIALS  OF  VACCINATION. 


ble  manner  the  dangers  of  this  practice.  In 
the  case  reported  by  Taylor,  a  number 
of  persons  were  vaccinated  in  succession  us- 
ing the  same  scarificator  without  cleaning  it. 
An  infant,  who  was  vaccinated  immediately 
after  a  young  prostitute  affected  with  syphi- 
lis, developed  a  chancre  at  the  point  of  inocu- 
lation, which  was  followed  by  the  usual 
general  lesions.  The  vaccine  employed 
was  in  quill  form  and  furnished  by  the 
Board  of  Health.^ 

Influence  of  other  Diseases  on  Vac- 
cinia.—It  has  been  observed  that  if  a  vac- 
cination have  been  successfully  performed 
during  the  incubation  stages  of  certain  dis- 
eases, e.g.,  measles,  scarlatina,  chicken-pox, 
and  the  early  or  febrile  stage  of  whooping 
cough,  and  the  vesicles  do  not  reach  their 
period  of  areola  before  the  particular  affec- 
tion manifest  itself,  it  will  frequently  happen 
that  the  areola  will  not  form  till  the  disease 
has  subsided,  sometimes  for  two  weeks  or 
more,  or  it  may  not  form  at  all.  On  the 
contrary  vaccinia  has  frequently  been  seen 

*  On   this  subject,  consult    F.  P.  Foster  in    the   Am.   Jour. 
Syph.  and  Derm,  1870-1871  and  vol.  iv,  1873. 


MODIFICATIONS,  ETC,  OF  VACCINIA,        61 

running  its   course  along  with  these  affec- 
tions and  uninfluenced  by  them. "^ 

The  respective  influence  of  small-pox  and 
vaccinia  upon  each  other  is  of  much  interest 
and  of  vital  importance  practically.  When, 
to  quote  Dr.  Seaton,  vaccination  has  be^n 
performed  on  any  one  who  is  incubating 
small-pox,  if  the  incubation  of  that  disease 
be  so  far  advanced  that  the  small-pox  mani- 
fest itself  within  two  or  three  days  of  the 
vaccination,  no  vaccine  vesicles  will  rise, 
but  small-pox  only  will  be  developed.  Un- 
der these  circumstances  variolous  vesicles 
will  often  be  met  with  on  the  vaccinated 
spots.  But  if  the  incubation  have  been  less 
advanced,  and  the  cow-pox  have  taken  local 
effect  before  the  small-pox  symptoms  set  in, 
the  further  progress  of  the  vaccination  may, 
or  may  not,  be  retarded.  Very  frequently  the 
two  diseases  may  be  seen  going  on  togeth- 
er.f  If,  however,  the  cow-pox  vesicles  had 
not  reached  the  stage  of  areola  before  the 
small-pox  set  in,  no  influence  will  be  exert- 

*  See  ref.  in  Seaton's  Hand  Book,  p.  87.  Dr.  J.  Lewis  Smith 
(Dis.  of  Children,  p.  208)  states  that  the  paroxysmal  cough  of 
pertussis  is  arrested  by  vaccinia,  to  return  when  the  pock  be- 
gins to  desiccate. 

f  Loc.  cit.,  p.  88. 


62  ESSENTIALS  OF  VACCINATION, 

ed  on  the  course  of  the  small-pox;  if,  on  the 
other  hand,  the  areola  be  fully  formed  around 
the  cow-pox  vesicles  before  the  small-pox 
symptoms  appear,  the  vaccination  will,  ac- 
cording to  its  date,  either  arrest  the  small- 
pox at  its  premonitory  stage  or  alter  and 
modify  the  course  of  the  eruption. 

Causes  of  Vaccinal  Irregularities 
and  Complications. — In  the  foregoing 
sections  mention  has  been  made  of  some  of 
the  causes  of  irregular  and  complicated  vac- 
cinia, and  in  a  chapter  to  follow  the  question 
will  be  still  further  discussed.  It  will  be  suf- 
ficient to  say  here,  that  in  some  cases  no  par- 
ticular cause  can  be  assigned  for  these  unto- 
ward results.  The  virus  may  be  all  that  could 
be  desired,  the  person  vaccinated  apparently 
in  perfect  health,  and  others  inoculated  from 
the  same  virus  may  present  typical  features, 
yet  the  vaccinia  fails  to  run  a  normal  course. 
In  most  instances,  however,  these  anomalies 
are  capable  of  direct  explanation.  Except- 
ing those  cases  where  there  is  an  indi- 
vidual predisposition  to  eruptive  disorders, 
epidemic  influences,  etc.,  the  fault  generally 
lies  with  the  source  of  lymph  supply,  the 
condition  of  the  person  vaccinated,  or  in  the 


MODIFICATIONS,  ETC.,  OF  VACCINIA.        63 


manner  of  operating.^  After  all,  the  devia- 
tions from  the  usual  course  of  vaccinia  are 
very  rare.  In  the  words  of  Dr.  Thin,  the 
overpowering  arguments  in  favor  of  vacci- 
nation are  not  weakened  by  such  exception- 
al cases ;  and  as  their  occurrence  does  not 
escape  the  notice  of  the  public,  the  legiti- 
mate influence  of  the  medical  attendant  can 
only  be  strengthened  by  his  being  able  to 
admit  and  explain  their  existence.f 

*  During  the  late  war,  especially  in  the  South,  the  spurious 
results  of  vaccination  were  of  frequent  occurrence.  Prof.  Jo- 
seph Jones,  as  a  consequence  of  his  investigations  on  Spurious 
Vaccination  in  the  Confederate  Army,  arrived  at  the  following 
conclusions  as  to  its  causes:  i.  Lowered  vitality — scorbutic 
condition.  2.  From  abnormal  lymph,  from  persons  previous- 
ly vaccinated  or  having  eruptive  diseases.  3.  Scabs  or  lymph 
undergoing  decomposition,  long  carried  about  the  person.  4. 
Mingling  vaccine  virus  with  that  of  true  variola,  as  in  per- 
sons having  varioloid.  5.  Virus  from  persons  having  erysipe- 
las, pyaemia,  gangrene,  and  suppurating  wounds.  6.  Lymph, 
scabs,  etc.,  from  persons  suffering  from  syphilis.  Quoted  in 
the  Proc.  Med.  Soc.  Kings  Co.,  October,  1880. 

f  Edin.  Med.  Jour.,  December,  1881. 


CHAPTER  VI. 

REVACCINATION. 

Course  of  Revaccination. — When  a 
person  who  has  undergone  a  successful 
primary  vaccination,  is  again  submitted  to 
the  operation,  there  will  be  either  no  re- 
sult; or  a  modified  effect,  running  an  ir- 
regular and  eccentric  course,  will  follow;  or, 
less  usually,  the  normal  course  of  the  regu- 
lar vaccinia  will  be  observed. 

The  results  of  vaccination  in  a  small 
number  of  persons,  even  in  recently  vac- 
cinated children  with  good  scars,  are  quite 
typical.*  In  the  majority,  however,  the 
effects  are  exceedingly  irregular;  in  some  in- 
stances papules,  with  some  effort  at  vesicula- 
tion,  occur;  in  others  acuminated  vesicles,  with 
hard  and  irregular  areolae,  arise,  the  whole 
process,  including  the  fall  of  the  scab,  being 
completed  by  the  eighth  day.  Meyer  f  pro- 
poses to  classify  the  results  obtained  in  re- 

*  This  statement,  so  far  as  regards  children,  is  made  on  Sea- 
ton's  authority.     I  have  never  witnessed  it. 

f  Vierteljahr.  f.  Derm.  u.  Syph.,  v.  Jahrg.,  1879,  2  u.  3  Heft. 

64 


RE  VACCINATION.  65 


vaccination  as  follows:  i.  Those  in  which 
the  pustules  *  run  the  course  of  primary 
vaccinia,  or  else  do  not  reach  their  acme  be- 
fore the  fifth  day.  2.  Those  in  which  they 
reach  their  acme  by  the  fourth  day.  3.  Those 
in  which  the  pustules  reach  their  acme  on 
the  second  or  third  day.  4.  Irregular  mani- 
festations (scales,  scabs),  or  else  none  at  all 
— negative  results. 

Severe  constitutional  symptoms  are  much 
more  frequent  after  revaccination  than  after 
the  primary  vaccination,  and,  so  far  as  my 
own  experience  goes,  certain  forms  of  vac- 
cinal eruptions  are  much  more  common.  I 
am  quite  convinced  that  during  the  preva- 
lence of  variola  epidemics,  the  susceptibility 
of  vaccinia  is  increased,  and  that  it  is  then 
not  uncommon  to  produce  some  degree  of 
result,  when  at  other  times  the  issue  would 
be  negative.f 

What  Constitutes  a  Revaccination? 

What  is  to  be  considered  a  vaccinal  effect 

*It  should  be  borne  in  mind  in  reading  foreign  literature  that 
the  vaccine  vesicle  is  generally  called  a  pustule. 

t  As  it  is  claimed  (Gregory)  that  puberty,  inflammatory  dis- 
eases, change  of  climate,  etc.,  revive  the  predisposition  to  va- 
riola, the  same  conditions  may  produce  analogous  results  for 
vaccinia. 

5 


66  ESSENTIALS  OF  VACCINATION, 

after  a  revaccination,  is  a  question  that  has 
been  variously  answered.  I  exclude  of 
course  those  cases  where  a  tolerably  normal 
vesicle  and  areola  are  developed:  but  refer 
particularly  to  slight  dermatitis,  infiltration 
of  the  skin,  more  or  less  developed  papules, 
and  abortive  vesiculation.  Niemeyer's^  in- 
vestigations, which  I  have  frequently  veri- 
fied, are  quite  pertinent  to  this  question. 
He  had  the  opportunity  of  following  day  by 
day  the  effects  of  revaccination  on  five  hun- 
dred recruits.  The  number  of  men  who 
developed  normal  pocks  was  proportionately 
small,  but  the  number  where  there  was  no 
result  was  equally  slight.  In  most  cases  a 
few  days  after  the  vaccination,  there  were 
redness,  infiltration  of  the  skin,  papules, 
vesicles,  etc.  Among  the  latter  class,  in 
many  cases,  eight  days  after  the  operation, 
the  inflammation  had  run  its  course,  and  if 
unwatched  during  the  interval,  they  would 
have  been  classed  among  those  where  the 
vaccination  had  no  effect.  These  inflamma- 
tions, he  continues,  may  have  been  the  result 
of  the  wound  from  the  lancet,  of  scratching, 
or  of  the  foreign  body  introduced  under  the 

*  Textbook  Pract.  Med.  vol.  ii,  p.  556;  New  York. 


REVACCINATION.  67 

epidermis;  but  at  the  same  time  it  was 
possible  that  they  were  due  to  incomplete 
vaccinia  running  a  rapid  course,  and  holding 
the  same  relation  that  varioloid  does  to  var- 
iola,— vaccinoid.  To  determine  this  point  he 
first  vaccinated  a  number  of  persons  with 
the  contents  of  blisters  and  pustular  erup- 
tions, and  in  none  of  them  was  the  result 
produced.  He  also  vaccinated  others  in 
whom  the  phenomena  mentioned  above  had 
been  observed,  and  in  these  also  he  failed  to 
get  similar  effects. 

How  often  should  Revaccination  be 
Performed. — The  idea  that  the  disease  vac- 
cinia, once  typically  received,  exhausts  all 
future  susceptibility  of  small-pox,  finds  no 
acceptance  at  the  present  time,  although  a 
fixed  article  of  faith  in  the  early  days  of  the 
practice.  There  is  no  reason  to  doubt  that 
the  most  perfect  vaccination  loses  its  effect 
in  the  course  of  years.  There  is  equal  rea- 
son to  believe,  however,  that  the  value  of 
the  protection  afforded  is  in  direct  propor- 
tion to  the  thoroughness  of  the  vaccination 
and  to  the  quality  of  the  lymph  employed. 
As  this  last  proposition  will  be  thoroughly 
discussed  in  a  subsequent  chapter,   I  shall 


68  ESSENTIALS  OF  VACCINATION, 

content  myself  with  certain  facts  as  they  now 
obtain,  and  not  as  they  may  perhaps  be 
under  more  efficient  vaccination  with  animal 
virus. 

In  the  first  place,  as  frequently  referred  to 
in  former  sections,  all  doubtful  primary  vac- 
cinations should  be  put  to  the  test  of  revac- 
cination.  It  is  the  moral  duty  of  the  medical 
man  to  see  to  it  that  the  operation  has  been 
surrounded  with  all  possible  safeguards. 
Again,  if  the  amount  of  vaccinal  effect  pro- 
duced be  not  so  great  as  was  expected,  or 
if  the  vaccine  scars  lack  the  appearance 
of  genuineness,  or  if,  while  typical  in  char- 
acter they  are  deficient  in  quantity,  I  can  see 
no  objection  to  a  further  vaccination.  But 
assuming  that  the  primary  vaccination  was 
normal  in  all  respects,  the  important  ques- 
tion still  remains  to  be  answered.  How  often 
should  revaccination  be  performed }  Sea- 
ton*^  in  his  excellent  treatise,  tells  us  as  the 
result  of  the  experience  of  many  observers, 
that  every  person  should  take  care  to  be  re- 
vaccinated  about,  or  soon  after,  the  period 
of  puberty.  He  states  that  under  ordinary 
circumstances  the  aoe  of  fifteen  is  the  best 

o 
*  Loc.  cit.  p.  305. 


REVACCINATION,  69 

time  for  it  to  be  done,  since  experience  has 
shown  that  the  most  danger  to  be  dreaded 
from  post-vaccinal  small-pox  is  from  the  age 
of  fifteen  to  twenty-five.  In  girls,  in  whom  the 
changes  connected  with  puberty  occur  early, 
the  revaccination  may  be  correspondingly  an- 
ticipated. Dr.  Welch,''-  of  the  small-pox  hos- 
pital in  Philadelphia,  regards  revaccination 
at  the  age  of  puberty  of  extreme  importance; 
but  also  states  that  when  there  is  danger  of 
infection  it  is  wise  to  revaccinate  all  persons 
who  have  been  vaccinated  more  than  five 
years. 

From  my  own  experience,  and  after  care- 
ful survey  of  the  whole  question,  and  iii 
view  of  the  general  inefficiency  of  vaccina- 
tion, and  especially  from  the  fact  that  indi- 
viduals undoubtedly  vary  as  to  the  immunity 
granted  by  vaccinia ;  I  should  say  that  under 
danger  of  infection,  revaccination  should  be 
performed  even  if  a  few  months  only  had 
elapsed  from  the  date  of  the  previous  inocu- 
lation ;  and  moreover  I  am  constrained  to 
agree  with  Trousseau  who  recommends  that 
vaccination  be  repeated  as  often  as  once 
every  five  years  ;  for  if  this  practice  be  un- 

*  Phila.  Med.  Times,  August  13,  1881. 


70  ESSENTIALS  OF  VACGINATIOK 

necessary  it  is  at  all  events  free  from  objec- 
tion. Finally,  it  may  be  stated  that  those 
most  experienced  in  the  use  of  true  bovine 
virus  claim  that  an  adult  revaccinated  with 
animal  lymph  will  be  as  fully  protected 
against  small-pox  for  the  rest  of  life  as,  "if 
he  or  she  had  twice  had  that  disease." 
(Martin). 


CHAPTER  VII. 

MERITS  OF  DIFFERENT  KINDS  OF  VACCINE 

VIRUS. 

General  Considerations. — It  has  been 
shown  in  another  chapter  that  vaccine  virus 
may  be  produced  in  a  variety  of  different 
ways.  For  practical  purposes  we  are  con- 
cerned only  with  that  kind  which  is  the  re- 
sult of  the  inoculation  of  a  series  of  human 
subjects  with  vaccine  lymph,  or  with  that 
other  kind,  called  by  Dr.  Martin,  "  heifer- 
transmitted  cow-pox  virus,"  the  animal  lymph 
of  European  writers,  which  has  never 
passed  through  the  human  organism.  In 
this  country,  where  vaccination  with  bovine 
virus  is  almost  the  universal  rule,  the  rela- 
tive merit  of  animal  and  humanized  lymph 
has  lost  much  of  that  burning  interest,  which 
still  attaches  to  it  in  Europe,  and  especially 
England,  where  the  so-called  Jennerian 
lymph  finds  many  staunch,  and  perhaps 
bigoted,  defenders;  still  the  subject  is  one 
of  much  scientific  and  practical  moment, 
and  will  require  somewhat  detailed  consid- 
eration. 71 


72  ESSENTIALS  OF  VACCINATION. 

Has  the  Prophylactic  Power  of  Vac- 
cinia Degenerated  ? — The  fact  that  vac- 
cine virus,  which  has  gone  through  many 
successive  transmissions  (cultures)  from  its 
original  source,  undoubtedly  loses  much  of  its 
prophylactic  influence,  would  seem  to  be  well 
established.  If  the  question  be  examined 
statistically,  we  shall  find  that  the  fewer  re- 
moves that  the  lymph  had  undergone  from 
its  original  fountain-head  in  the  cow,  the 
more  marked  was  the  freedom  from  post- 
vaccinal small-pox;  while  as  time  rolled  on 
and  the  lymph  became  weakened  by  innu- 
merable transmissions,  the  frequency  of  post- 
vaccinal variola  correspondingly  increased. 

In  1802,  about  four  years  after  Jenner  had 
made  public  his  discovery,  a  committee  of 
the  House  of  Commons  thoroughly  investi- 
gated the  subject,  with  a  view  of  determin- 
ing his  claims  to  a  national  reward,  and  suc- 
ceeded in  finding  only  two  cases  in  which 
small-pox  had  occurred  after  properly  per- 
formed vaccination.  A  number  of  special 
inquiries  made  in  immediately  succeeding 
years  gave  the  same  general  results.  Even 
as  late  as  thirteen  years  after  the  practice 
had  been  introduced,  no  fatal  case  of  post- 


MERITS  OF   VACCINE   VIRUS.  73 

vaccinal  small-pox  had  been  recorded.  In 
Copenhagen,  at  the  time  a  city  of  over  one 
hundred  thousand  inhabitants,  where  vacci- 
nation was  universally  practised,  not  a  sin- 
gle death  from  small-pox  was  recorded  dur- 
ing the  thirteen  years,  1811-23.  In  Anns- 
pach,  Bavaria,  with  a  population  of  about 
three  hundred  thousand,  no  death  from 
small-pox  took  place  in  the  nine  years, 
1 8 10-18.  Of  more  than  two  and  a  half  mill- 
ions of  people  vaccinated  in  France  between 
the  years  1804  and  1813,  only  seven  were 
known  to  have  contracted  variola. 

With  these  facts  in  view,  it  is  not  at  all 
surprising  that  Jenner  should  have  dreamed 
of  the  possibility  of  exterminating  small-pox 
from  the  face  of  the  earth;  and  it  is  well  known 
that  up  to  the  close  of  his  life  (1823)  he  reso- 
lutely opposed  the  idea  of  the  decay  of  the 
vaccine  influence  by  the  lapse  of  years,  and 
proposed  a  number  of  theories  to  account 
for  the  fact  which  each  day  was  becoming 
more  apparent,  viz. :  the  more  frequent  oc- 
currence of  post-vaccinal  small-pox. 

But  even  before  Jenner  s  death,  small-pox 
after  vaccination  was  becoming  more  frequent 
and  more  fatal,  and  this  frequency  and  fatality 


74  ESSENTIALS  OF  VACCINATION, 

have  steadily  increased.  Thus,  in  France, 
from  1819-35,  there  were  registered  5,467 
cases  of  small-pox  after  vaccination,  of  which 
fifty-one  were  fatal.  In  Switzerland,  4,211 
cases  occurred  between  the  years  1822-32, 
with  ninety-two  deaths.  Several  epidemics 
occurred  in  Copenhagen,  from  1825-35,  in 
which  it  is  noted  that  there  were  3,093  post- 
vaccinal cases,  and  sixty-six  deaths. 

Further  statistics  could  be  adduced  to 
prove  the  greater  frequency  and  fatality  fol- 
lowing the  use  of  long-humanized  virus  ;  but 
I  shall  bring  to  an  end  this  part  of  our  in- 
quiry by  appending  the  conclusions  reached 
by  Dr.  Cameron  in  his  able  and  exhaustive 
essay  on  this  subject  \'^' 

I.  That  the  protection  against  small-pox 
afforded  by  the  vaccine  lymph  in  use  in  this 
country  (England),  though  still  great,  has 
become  much  less  than  it  was  when  the 
lymph  had  undergone  comparatively  but 
few  transmissions  through  the  human  sub- 
ject. 

*  Fortnightly  Review,  May,i88i.  I  am  indebted  to  this  article 
for  much  material,  also  to  the  able  paper  on  vaccination  by  Prof. 
C.  A.  Lindley,  M.D.,  in  the  Fourth  Annual  Report  of  Connecti- 
cut State  Board  of  Health,  1S82. 


MERITS  OF   VACCINE   VIRUS.  75 

2.  That  the  number  of  cases  of  small-pox 
occurring  per  million  of  vaccinated  persons 
is  very  mjach  greater  than  that  shown  in  the 
records  of  vaccinated  populations  in  the 
earlier  part  of  the  century. 

3.  That  the  death  rate  in  recorded  cases 
of  post-vaccinal  small-pox  has  progressively 
increased  in  all  cases,  with  and  without 
marks,  from  1.75  per  cent  in  1819-35  to  over 
10  per  cent  in  1870-79,  and  in  cases  with 
marks  from  6.9  per  cent  in  183 1-5 1  to  9.2 
per  cent  in  1870-79. 

4.  That  this  increase  in  mortality  has  been 
remarkable  in  the  best  vaccinated  classes  of 
cases,  the  death  rate  in  cases  with  three  or 
more  cicatrices  in  1870-79  being  twice  what 
it  was  in  1852-67;  and  the  death  rate  in 
cases  with  three  or  more  good  cicatrices  in 
187079  being  thrice  what  it  was  in  1852-67. 

5.  That  the  proportion  in  which  vacci- 
nated children  are  attacked  and  cut  off  by 
small-pox  has  alarmingly  increased,  being 
many  times  greater  during  the  last  decade 
than  it  was  thirty  or  forty  years  earlier  ;  and, 

6.  That  while  the  death  rate  in  small-pox 
occurring  in  unvaccinated  persons  has  varied 
in  the  different  groups  recorded,  and  was  ex- 


76  ESSENTIALS  OF  VACCINATION, 


ceptionally  high  in  1870-79,  the  progressive 
advance  of  mortaHty  in  post-vaccinal  small- 
pox is  not  to  be  attributable  to  epidemic  in- 
fluence, being  equally  observed  in  successive 
groups  of  cases  in  which  the  mortality  from 
natural  small-pox  shows  a  diminution. 

Examined  from  another  point  of  view 
anyone  can  satisfy  himself  of  a  marked  dif- 
ference, both  local  and  constitutional,  which 
will  be  exhibited  according  as  the  operation 
of  vaccination  has  been  performed  with  long 
humanized  lymph  or  with  the  fresher  bovine 
virus.  The  Jennerian  lymph  will  produce  a 
vaccinal  lesion  which  will  run  through  its 

o 

various  stages  much  more  rapidly,  and  the 
whole  process,  including  the  fall  of  the  crust, 
will  have  been  accomplished  by  the  four- 
teenth or  seventeenth  day.  On  the  contrary, 
the  march  of  the  vaccinal  process  after  the 
use  of  animal  lymph  is  much  more  deliber- 
ate, and  the  crust  rarely  falls  before  the 
twenty-first  day,  and  frequently  not  till  a 
longer  period.  In  brief,  the  often  depre- 
cated ''violence"  of  bovine  virus  gives  us 
the  best  assurance  that  we  are  dealing  with 
a  stock  that  has  lost  none  of  its  pristine 
vigor,  and  which  most  corresponds  in  its  sev- 


MERITS  OF  VACCINE  VIRUS,  77 

eral  phenomena  to  the  vaccinations  of  the 
early  Jennerian  days. 

The  Disadvantages  of  Humanized 
Virus. — The  gravest  charge  that  could  be 
brought  against  humanized  virus  has  been 
considered  in  the  preceding  section,  namely, 
that  when  long  humanized  it  loses  much  of 
its  power  of  granting  immunity  against  vari- 
ola. But  even  if  this  objection  were  not  valid, 
there  are  a  number  of  others  of  serious  im- 
^portance.  It  has  been  found  in  England,  a 
country  where  vaccination  is  compulsory, 
and  where  the  means  of  carrying  out  the 
practice  are  arra-nged  upon  the  most  com- 
prehensive scale,  that  sole  dependence  upon 
human  vaccine,  particularly  during  epidem- 
ics, sometimes  places  the  authorities  in  diffi- 
cult and  dangerous  straits.  If  "  vaccine 
famines  "  are  possible  in  Great  Britain,  how 
much  more  likely  would  they  be  in  countries 
where  there  exists  no  State  provision  for 
the  proper  cultivation  and  dissemination  of 
humanized  lymph.*^ 

*  For  a  full  consideration  of  all  the  points  bearing  on  this 
question,  with  which,  however,  the  American  reader  is  inter- 
ested in  a  historical  and  scientific,  rather  than  in  a  practical  way, 
I  would  refer  to  Martin's  valuable  paper,  already  freely  quoted, 
in  the  Trans.  Am.  Med.  Ass'n  for  1877. 


78  ESSENTIALS  OF  VACCINATION, 

It  seems  to  be  quite  universally  acknowl- 
edged that  erysipelas  occurs  with  unusual 
frequency  after  the  use  of  humanized 
lymph,  and  if  it  can  be  established  that  the 
bovine  virus  is  free  from  this  serious  disad- 
vantage, no  one  should  hesitate  to  encourage 
its  general  use. 

No  one  denies  that  syphilis  has  been 
transmitted,  or  rather  inoculated  by  vacci- 
nating with  humanized  virus,  and  this  deplor- 
able fact,  rarely  as  it  has  occurred,  brings  us 
to  one  of  the  most  important  disadvantages 
of  virus  which  has  passed  through  the  human 
system,  viz  :  that  its  employment  has  de- 
stroyed public  confidence  in  vaccination. 

The  Advantages  of  Bovine  Virus. — 

Relying  upon  the  statistical  information 
which  has  been  presented,  showing  the  infre- 
quency  and  small  mortality  of  variola  in  the 
early  history  of  vaccination,  that  is,  in  the 
days  when  humanized  lymph  had  undergone 
but  few  transmissions  from  the  natural  dis- 
ease in  the  cow,  the  conclusion  would  seem  to 
be  fully  warranted  that  frequently  renewed 
bovine  virus  would  afford  an  equal  protec- 
tion in  our  day.      M.  VVarlomonf^  strongly 

*Brit.  Med.  Jour.,  November  12,  1881. 


MERITS  OF   VACCINE   VIRUS.  79 

reiterates  the  assertion  made  by  him  as  to 
this  matter  some  years  ago.  He  states  that 
out  of  more  than  ten  thousand  children 
vaccinated  at  Brussels  with  animal  vaccine 
from  1869-70,  not  one  case  has  to  his  knowl- 
edge been  reported  as  having  been  attacked 
by  the  terrible  epidemic  that  ravaged  Europe 
soon  after.  He  has  made  a  number  of  appeals 
for  information  as  to  cases  of  variola  after 
animal  vaccination,  but  so  far  without  result. 
Others  have  made  similar  requests,  and 
have  offered  large  rewards  for  such  informa- 
tion, but  without  avail. 

It  has  been  repeatedly  urged  by  some 
that  bovine  virus  "  does  not  take  well." 
Without  any  reference  to  individual  suc- 
cess, which  of  course  depends  altogether 
upon  personal  skill  and  experience,  we 
have  recently  been  put  in  possession  of 
certain  statistics,  which  show  that  in  ex- 
perienced hands  animal  vaccination  gives, 
to  say  the  least,  as  good  a  percentage  of 
successes  as  can  be  exhibited  by  vaccination 
done  with  ordinary  current  lymph  by  equally 
skilled  vaccinators.  Dr.  Warlomont"^  writes 
that  when    calf-lymph  is   inoculated  direct, 

*  Loc.  cit. 


80  ESSENTIALS  OF  VACCINATION, 

taken  from  good  pustules  at  the  proper  age,- 
no  other  failures  are  known  but  those  result- 
ing from  the  manipulations  of  the  operator. 
Out  of  three  hundred  children  thus  vaccin- 
ated by  himself,  not  one  puncture  failed  to 
produce  a  good  pustule.  When  preserved 
vaccine  was  used  in  primary  vaccination  the 
successes  were  at  the  rate  of  ninety-six 
per  cent.;  and  in  revaccinations  at  the  rate 
of  sixty-two  per  cent.  Dr.  Martin,  in  this 
country,  reports  his  successes  in  revaccin- 
ation  to  be  "  exactly  seventy-three  per  cent, 
at  the  first  attempt ;  "  and  if  those  cases 
which  fail  to  be  affected  at  the  first  trial  are 
twice  more  attempted,  the  result  is  raised  to 
a  fraction  over  eighty  per  cent.  Dr.  Brown- 
ing gives  his  percentage  of  successes  in  up- 
wards of  one  thousand  vaccinations  and  re- 
vaccinations  as  97.13  per  cent.  He  states 
that  Dr.  Renner's  percentage  of  successes 
is  98.3.^ 

Mr.  Ernest  Hart,f  in  a  recent  address  on 
animal  vaccination,  presents  some  further 
statistics,  which  were  supplied  him  by  Dr. 
Carstan,  of  The  Hague,  as  follows: 

*  Med.  Times  and  Gaz.,  February  25,  1882. 
f  Brit.  Med.  Jour.,  November  26,  1881. 


MERITS  OF  VACCINE   VIRUS.  81 

''  In  1869,  when  animal  vaccination  was 
begun  in  Rotterdam,  there  were  sixty-seven 
failures  out  of  542  operations;  last  year 
(1880)  there  were  only  four  failures  in  2727 
operations,  whilst  in  1563  of  these  the  full 
amount  of  ten  vesicles  was  obtained.  At 
Amsterdam,  there  were  nineteen  failures  in 
1879 — when  animal  vaccination  was  started 
— out  of  626  operations  ;  whilst  during  the 
last  six  years  there  has  been  but  one  single 
failure  out  of  a  total  of  14,849  operations. 
Similar  experience  comes  from  The  Hague, 
Utrecht  and  Haarlem  ;  and  the  gross  total 
of  all  the  vaccinations  performed  in  Holland 
with  animal  lymph,  including  all  the  early 
efforts,  shows  that  out  of  60,754  operations 
only  720,  or  little  more  than  one  per  cent., 
have  been  unsuccessful." 

''  Testimony  such  as  this,"  says  Mr.  Hart, 
"  and  on  so  large  a  scale,  shows  indisputably 
that  the  allegations  made  against  the  taking 
power  of  calf  lymph  have  no  foundation  in 
fact." 

The  rather  enthusiastic  claim   made  for 

animal  lymph,  that  erysipelas  is  never  known 

to  occur  from  its   use,  and  further  that  it 

may  indeed  be  looked  upon  as  a  prophy- 
6 


82  ESSENTIALS  OF  VACCINATION, 

lactic  against  that  disease,  I  think  is  subject 
to  criticism.  The  prime  fact  remains,  how- 
ever, that  while  erysipelas  was  only  too 
frequent  an  accompaniment  of  humanized 
virus  vaccinations,  it  is  rarely  attendant 
upon  properly  performed  operations  done 
with  carefully  selected  bovine  virus.  I  am 
convinced  that  those  having  experience 
with  both  kinds  of  lymph  will  unquestion- 
ably confirm  this  statement. 

Above  all,  the  assurance  that  it  is  not  pos- 
sible to  convey  syphilis  by  means  of  animal 
vaccination,  gives  the  practice  a  value  which 
is  paramount.  There  is  neither  scientific  nor 
practical  evidence  that  any  of  the  diseases 
of  animal  life  have  ever  been  inoculated  by 
means  of  bovine  virus.  Finally,  one  of  the 
greatest  advantages  of  animal  vaccination 
lies  in  the  fact  that  any  quantity  of  vaccine 
lymph  may  be  produced  at  will. 

Disadvantages  of   Bovine   Virus. — 

The  disadvantages  which  may  arise  from  the 
use  of  bovine  virus  can  be  summed  up  in  one 
word — the  lack  of  proper  supervision  over 
its  cultivation.  If  all  *'  propagators  "  Vv^ere  as 
skilled  and  honest  as  we  know  some  of  them 
to  be,  the  necessity  for  legal  control  of  some 


MERITS  OF  VACCINE   VIRUS.  83 

sort  would  not  be  demanded ;  but  it  is  a  no- 
torious fact  that  bovine  virus  cultivation  is 
carried  on,  in  some  instances,  in  a  manner 
so  ignorant  that  it  would  be  amusing  if  it 
were  not  criminal.  It  is  no  doubt  true  that 
various  untoward  results,  such  as  erysipelas, 
local  inflammatory  neoplasms,  ulcerations, 
and  even  tetanus, "^^  have  followed  the  use  of 
"  commercial "  bovine  virus,  especially  dur- 
ing the  past  winter;  but  it  should  be  remem- 
bered that  if  proper  discretion  be  exercised 
in  the  selection  of  animal  lymph  such  un- 
fortunate consequences  would  be  averted. 
Moreover,  it  should  not  be  forgotten  that 
such  ill  effects,  and  worse,  are  known  to 
have  followed  the  employment  of  human- 
ized vaccine.  The  distressing  experience  of 
the  confederate  army,  referred  to  in  a  pre- 
ceding section,  could  hardly  have  occurred 
under  the  use  of  bovine  virus.  The  ac- 
knowledged disadvantages  of  animal  vac- 
cination could  be  quickly  remedied  if  the 
national  or  state  boards  of  health  had  power 
to  control  its  application. 

*St.  Louis  Courier  of  Med.,  April,  1882, 


CHAPTER  VIII. 

METHODS  OF  OBTAINING  AND  STORING 
VACCINE  VIRUS. 

Propagation  of  Bovine  Virus.^ — The 

practice  of  propagating  bovine  virus  is  not 
the  simple  matter  that  business  cupidity 
would  make  it;  but,  on  the  contrary, requires 
great  technical  skill,  knowledge  and  perse- 
verance on  the  part  of  the  physician,  by 
whom  alone  such  work  should  be  undertak- 
en. The  essential  features  in  the  proper 
and  safe  carrying  on  of  animal  vaccination 
are  as  follows:  i.  To  use  for  the  purpose 
carefully  chosen  healthy  calves  of  a  suitable 
age  and  trustworthy  pedigree.  2.  To  keep 
them  in  separate  stalls  in  well  ventilated 
and  drained  stables.  3.  To  so  arrange  their 
diet  as  to  guard  against  intestinal  or  other 
derangements.  4.  To  protect  the  inoculated 
parts  from  all  contact  with  decomposing  ma- 

*  For  much  valuable  information  in  regard  to  the  practical  de- 
tails of  animal  vaccination,  I  am  indebted  to  Dr.  Frank  P.  Fos- 
ter, of  New  York.  I  have  also  drawn  largely  on  the  admirable 
report  of  vaccine  farms  made  by  Dr.  James  Law  to  the  Nation- 
al Board  of  Health,  in  their  Bulletin  for  April  i,  1882. 

84 


OBTAINING  AND  STORING.  85 

niire  or  faeces.  5.  The  taking  of  the  lymph 
at  the  proper  period,  and  from  unbroken 
vesicles.  6.  The  thorough  purification  of 
the  material  upon  which  the  virus  is  to  be 
stored,  and  its  subsequent  protection,  both 
before  and  after  charging,  from  flies  and 
other  insects.  Law  objects  to  the  practice 
of  taking  calves  indiscriminately  for  the 
purpose  of  inoculation,  and  suggests  that 
the  best  interests  of  vaccination  would  be 
served  if  the  progeny  of  vigorous  and 
sound  animals  only  were  used,  and  for  this 
purpose  recommends  that  a  large  breeding 
herd  be  kept  on  hand  under  the  supervision 
of  an  accomplished  veterinarian.'^  The 
same  observer  warns  against  the  preference 
given  for  calves  of  the  Jersey  breed,  that 
stock  being  particularly  prone  to  tuberculo- 
sis. I  believe  that  calves  between  three  and 
six  weeks  of  age  are  the  most  suitable  for 
vaccination;  but  some  experienced  vaccina- 
tors employ  calves  somewhat  older — six  to 
eighteen  months — they  being  more  indepen- 
dent as  to  diet,  and  said  to  give  a  larger 
yield  of  lymph. 

'^^  In  Holland  a  veterinary  surgeon  is  attached  to  every /a?r 

vaccino^ene. 


86  ESSENTIALS  OF  VACCINATION. 

After  the  calf  selected  has  been  fastened 
down  on  a  properly  constructed  table,  the 
part  to  be  operated  upon  should  be  washed 
with  a  weak  thymol  or  carbolic  acid  lotion, 
and  then  shaved,  and  subsequently  re- 
washed  wath  the  antiseptic  solution.  The 
lower  third  of  the  belly  is  usually  chosen 
for  lymph  insertion,  but  from  the  liability 
of  the  parts  to  exposure,  to  pressure  and 
friction,  and  danger  from  contact  with  urine 
and  faeces,  it  has  been  suggested  by  Dr. 
Law  that  the  dorsal  rather  than  the  ven- 
tral surface  be  selected. "^^  In  all  cases  it 
is  well  to  protect  the  inoculated  parts  with 
a  canvas  cover.  Not  more  than  sixty  or 
seventy  finger-nail-size,  very  superficial,  abra- 
sions are  usually  made. 

According  to  Dr.  Foster,f  "  the  incubation 
varies  from  three  to  six  days.  The  stage  of 
vesiculation  follows  a  rapid  course — frequent- 
ly the  calf  will  seem  to  show  no  sign  of  success 
on  the  seventh  day,  and  on  the  following 
day  the  efflorescence  is  at  its  height.  Incrus- 
tation begins  speedily,  and  the  crusts  soon 

*  The  objection  that  the  animal  would  lick  the  inoculated 
surfaces  of  the  back,  Law  states  could  be  prevented  by  apply- 
ing beads  around  the  neck,  as  in  blistered  horses. 

f  Personal  communication. 


OBTAINING  AND  STORING.  87 

mature.  The  vesicle  is  not  usually  so  pro- 
nounced as  in  the  human  subject,  and  it  is 
never  surrounded  by  an  areola.  The  crusts 
are  seldom  characteristic  (owing  perhaps  to 
traumatism).  The  temperature  rises  about 
two  degrees  at  the  height  of  the  disease,  but 
otherwise  there  is  seldom  any  sign  of  fever. 
A  calfs  normal  temperature  is  one  hundred 
degrees." 

Some  difference  of  opinion  exists  as  to 
the  proper  time  for  taking  the  lymph.  Dr. 
Foster  considers  the  lymph  to  be  good  as 
long  as  it  is  clear.  Others  claim  that  the 
earlier  it  is  secured  the  better.  It  has  been 
said  that  the  virus  is  most  intense  from  the 
third  to  the  seventh  day.  Dr.  Browning,* 
an  English  vaccinator,  v/rites  that  the  vesi- 
cles should  be  opened  as  soon  as  acumi- 
nation  is  observed,  up  to  the  fifth  day,  in- 
clusive. Dr.  Griffith  f  declares  that  up  to 
the  seventh  day  the  unbroken  vesicle  con- 
tains no  superadded  products,  and  will  in- 
duce uncomplicated  vaccinia ;  but  that  at  a 
later  period  the  ruptured  vesicle  becomes 
the  nidus  of  septic  and  other  bacteria.     Un- 

*  Med.  Times  and  Gaz.,  February  25,  1882. 
•f  Quoted  bv  Dr.  Law..  lor„  rJt. 


88  ESSENTIALS  OF  VACCINATION. 

der  favorable  circumstances  it  is  possible  to 
charge  from  two  to  four  thousand  points 
from  the  yield  of  one  heifer;  but  when  to 
collect,  and  how  much  to  collect,  are  often 
matters  of  individual  experience  as  applied 
to  particular  cases.  It  is  manifest  that  only 
clear  lymph,  taken  from  unbroken  vesicles, 
should  be  employed,  and  from  animals  which 
exhibit  no  abnormal  symptoms. 

Collection  and  Storage  of  Bovine 
Virus. — The  methods  of  collecting  and  stor- 
ing animal  lymph  vary  somewhat, and  will  re- 
quire a  brief  description.  The  custom  which 
prevailed  at  Milan  of  cutting  out  the  pus- 
tule and  using  the  whole  mass  for  vaccina- 
tion has  been  very  justly  condemned.  It  is 
difficult  to  understand  how  so  reckless  a 
^  proceeding  should  ever  have  been  tolerated. 
Dr.  Browning  advises  that  the  vesicle  be 
pinched  up  with  forceps.  Any  colored  exu- 
dation or  serosity  that  exudes  is  wiped  off, 
and  the  vesicle  is  removed  with  a  broad 
double-edged  scalpel,  and  drained  by  slight 
pressure  on  to  a  piece  of  glass.  The  dry 
scab  is  left  alone  for  fear  of  septism,  but  the 
pool  of  lymph  running  from  it  is  ''micro- 
scoped"  and  used  as  necessary.     At  one  of 


OBTAINING  AND  STORING.  89 

our  most  trustworthy  vaccine  establishments 
it  is  the  custom  to  first  remove  the  crusts  that 
form  over  the  patches,  to  seize  the  vesicle 
between  the  blades  of  a  pair  of  long  dressing^ 
forceps,  and  as  soon  as  the  lymph  begins  to 
exude,  to  charge  the  points  on  both  sides. 
Others  claim  to  collect  the  lymph  on  the 
points  without  pressure.  At  one  establish- 
ment the  lymph  is  said  to  be  collected  in 
small  bottles  without  pressure,  and.  the 
points  are  afterwards  dipped  into  these,  thus 
obtaining  the  mixture  of  lymph  from  the 
various  inoculated  patches. 

Some  excellent  authorities  on  animal  vac- 
cination, among  them  Martin  and  Foster,* 
claim  that  the  presence  of  blood  in  the  lymph 
is  of  no  importance;  others  urge  that  all 
specimens  of  virus  should  be  free  from  blood 
corpuscles.  Generally  speaking,  admixture 
of  blood  with  animal  lymph  must  be  regarded 
as  objectionable  ;  but  in  the  hands  of  honest 
and  experienced  propagators,  who  select 
healthy  calves  and  attend  faithfully  to  all  the 
details  of  the  practice,  I  should  look  upon 
the  presence  of  blood  as  not  particularly 
contra-indicated,  aside  from  the  fact  that  it 

*  Proc.  Med.  Soc.  King's  Co.,  October,  1880. 


90  ESSENTIALS  OF  VACCINATION, 

is  practically  very  difficult  to  avoid  it.  The 
case  is  very  different  with  humanized  virus. 
Bovine  virus  may  be  variously  stored 
for  preservation  and  use.  The  crust  may 
be  used,  or  the  lymph  may  be  preserved 
between  glass  plates,  in  capillary  tubes,  or 
dried  upon  quill  slips  and  ivory  points.  I 
have  the  authority  of  Dr.  Foster  for  the 
statement  that  bovine  crusts  are  almost 
wholly  worthless,  which  agrees  entirely  with 
my  own  experience.  It  is  a  difficult  mat- 
ter to  obtain  crusts  that  are  free  from  blood, 
pus,  and  casual  impurities  of  all  sorts.  Up- 
on the  Continent  and  in  England  glass 
squares  are  sometimes  used.  I  am  not 
aware  that  this  method  is  practiced  here. 
Most  of  our  vaccinators  also  discard  the 
capillary  tubes.  This  most  excellent  method 
for  the  long  preservation  of  humanized  lymph 
has  been  found  unsuitable  for  bovine  virus. 
Dr.  Warlomont^  however,  claims  excellent 
results  with  them  when  prepared  in  the  fol- 
lowing manner:  The  lymph  is  first  collected 
in  large  glass  tubes,  two  or  three  millimeters 
in  diameter ;  after  a  short  interval  of  time, 
it  is  deposited  in  §  capsule  of  glass  or  por- 

*  Brit.  Med.  Jour.,  November  12,  1881. 


OBTAINING  AND  STORING.  91 

celain,  when  it  separates  itself  into  a  clot 
surrounded  by  serum.  When  all  the  serum 
has  been  thoroughly  pressed  out  and  the 
clot  reduced  to  its  minimum,  the  liquid  thus 
obtained  is  introduced  into  its  permanent 
depository,  which  is  closed  up  with  a  prepa- 
ration of  paraffine  or  asphalt.  If  the  vac- 
cine be  not  required  for  immediate  use,  a 
very  small  quantity  of  distilled  water  is 
added,  with  about  one-tenth  part  of  glycer- 
ine, to  prevent  any  consecutive  changes. 
If  the  virus  is  to  be  used  very  soon  after  it 
is  put  up  this  addition  will  not  be  necessary. 
Quill  slips  and  ivory  points  are  the  favorite 
method  for  preserving  dry  lymph.  The  first- 
named  are  preferred  by  many  propagators, 
the  ivory  points  being  considered  too  porous, 
absorbing  too  much  lymph  on  the  one  hand, 
and  giving  it  up  too  meagerly  on  the  other. 
My  personal  preference  is  for  the  well-pre- 
pared ivory  points,  since  they  are  also  very 
convenient  and  cleanly  for  use  in  vaccinat- 
ing; besides  I  have  not  failed  to  get  a  good 
percentage  of  successes  from  their  employ- 
ment. The  essential  thing  to  be  attended 
to,  whichever  be  selected,  is  to  see  to  their 
thorough  purification   before  their  coating 


92  ESSENTIALS  OF  VACCINATION. 

with  Ij^mph,  and  their  prompt  drying  and 
seclusion  from  extraneous  influences  after- 
ward."^^ 

Lymph  in  the  dry  state,  provided  it  be 
kept  in  a  cool  place,  may  retain  its  infectious 
qualities  for  a  long  period  ;  but  as  a  rule  slips 
are  valueless  after  a  week  or  ten  days,  and 
if  carried  about  in  the  pocket  or  other  warm 
place  rapidly  deteriorate.  Finally,  it  should 
be  stated  that  direct  vaccination  from  the 
calf  with  living  lymph  should  be  practiced 
when  practicable,  as  it  holds  about  the  same 
relation  to  safety  and  efficiency  as  does  arm- 
to-arm  vaccination  in  the  human  subject. 

Methods  of  Obtaining  Humanized 
Virus. — It  is  obvious  that  the  same  rules 
hold  good  for  the  human  vaccinifer  as  for 
the  calf,  namely,  that  the  vaccine  lymph  or 
crust  should  be  taken  only  from  such  sub- 
jects as   are  healthy  and  born   of  healthy 

■^  Patent  lymph  cones,  of  which  I  have  no  personal  experience, 
are  said  to  be  both  fraudulent  and  dangerous.  Microscopical 
examination  of  the  mass  which  they  contain  shows  them  to  be 
made  up  of  animal  and  vegetable  debris  of  various  sorts.  Prof. 
Lindsley  states  that  he  has  been  informed  that  an  amount  of 
"  consolidated  solid  lymph,"  enough  to  make  one  of  these  cones, 
could  not  be  produced  for  more  than  one  hundred  times  the  price 
named  in  the  advertisement.  Very  serious  results  are  reported 
as  having  occurred  from  their  use. 


ORTAINING  AXD  STORING.  93 

parents.  As  a  matter  of  course,  the  virus 
should  be  the  product  of  perfectly  normal 
vaccinia,  occurring  m  a  child  not  previously 
vaccinated.^  Lymph  may  be  taken,  so  far 
as  effectiveness  is  concerned,  as  soon  as  the 
vesicle  will  yield  it;  it  is  best  taken,  and  can 
be  gotten  in  largest  quantities,  when  the 
vesicle  is  fully  formed,  but  before  the  areola 
appears,  or  within  a  very  few  hours  of  its 
commencement,  which  in  regular  cases  is  the 
day  week  of  the  vaccination.  The  most  ex- 
perienced vaccinators  are  agreed  that  lymph 
should  not  be  taken  at  a  later  age  of  the 
vesicle,  for  while  it  will  yield  it  in  greater 
abundance,  it  does  not  take  with  certainty, 
and  according  to  Seaton  and  others  is  more 
apt  to  lead  to  erysipelatous  and  spurious 
results.  Good  lymph  is  more  or  less  viscid, 
.  and  not  thin  and  serou§.  For  the  purpose 
of  obtaining  the  lymph,  the  vesicle,  being 
cellular  in  structure,  should  be  opened  by  a 
number  of  minute  punctures  on  its  surface, 
and  not  around  the  base,  for  fear  of  blood 
admixture.    If  by  inadvertence  any  blood  be 

^  The  italicized  caution  would  seem  unnecessary,  if  the  writer 
were  not  familiar  with  instances  of  vaccination  done  with  the 
products  of  revaccination  in  adults. 


94  ESSENTIALS  OF  VACCINATION. 

drawn,  this  should  be  allowed  to  coagulate 
and  carefully  removed  before  any  lymph  Is 
taken.  On  no  account  should  the  vesicle 
be  pinched  or  squeezed  to  obtain  a  greater 
supply."^  In  America  the  majority  of  practi- 
tioners have  been  in  the  habit  of  using  the 
spontaneously  separated  crust  for  vaccina- 
tion. According  to  Scofield,f  Mr.  Bryce  was 
the  first  to  recommend  the  scab  as  a  substi- 
tute for  the  lymph. 

Various  Modes  of  Storage  of  Hu- 
manized Virus. — Vaccine  virus  from  the 
human  subject  may  be  preserved  for  use  be- 
tween glasses,  in  capillary  tubes,  upon  points, 
and  in  the  crust.  For  immediate  use  it  is 
sometimes  the  custom  for  practitioners  to 
coat  the  points  of  their  lancets  with  lymph, 
but  the  practice  is  not  commended  if  there 
should  be  a  delay  of  more  than  a  few  hours. 
The  vaccine  bottle,  a  small  phial  with"  a  glass 
stopper,  made  in  such  a  manner  that  its  in- 
ner surface  projects  into  the  bottle  in  the 
form  of  an  oblong  plate  of  glass,  on  which 
the  lymph  is  collected,  is  also  employed  for 
immediate  use.     Or  the  lymph  may  be  col- 

*  Seaton's  Handbook,  pp.  123,  124. 

f  Pract.  Treatise  on  Vaccinia  or  Cow-pock;  New  York,  1810. 


OBTAINING  AND  STORING,  95 

lected  between  plates  of  glass,  one  of  which 
may  if  desirable  contain  a  cup-like  depres- 
sion at  its  center. 

Seaton  mentions  to  condemn  the  proposi- 
tion which  has  been  made  of  keeping  lymph 
liquid  by  mixing  it  with  glycerine.  He  says 
that  aside  from  the  manifest  objection  to 
using  anything  but  pure  and  unmixed  lymph, 
he  knows  that  this  practice  has  given  rise  to 
a  large  relative  amount  of  failures.  Cursch- 
mann,"^^  on  the  contrary,  declares  that  the 
lymph  and  glycerine  mixture  appears  to 
keep  quite  as  well  as  the  unmixed  lymph, 
and  asserts  that  the  certainty  of  result  is 
not  at  all  less  than  after  the  use  of  pure 
lymph.  Muller,  who  introduced  this  method, 
usually  mixes  the  lymph  carefully  with  two 
parts  of  glycerine  and  two  parts  of  distilled 
water  (by  means  of  a  small  brush  in  a  watch 
glass),  and  preserves  the  liquid  in  air-tight 
capillary  tubes.  This  mixture,  according  to 
Muller,  can  be  still  further  diluted  (one  to 
eight)  without  perceptible  deterioration. 
Reiter  has  obtained  a  feeble  action  with 
dilutions  of  one  part  lymph  to  two  hundred 
of  water.     I  cannot  help  regarding  any  at- 

*  Ziemssen's  Cyclop,  vol.  ii,  p.  413,  Am.  Edit. 


96  ESSENTIALS  OF  VACCINATION 

tempt  at  lymph  dilution  as  highly  pernicious, 
and  calculated  to  lead  to  much  present  and 
future  mischief. 

A  very  common  method  of  preserving  hu- 
manized lymph  is  by  means  of  the  capillary 
tubes,  and  for  long  storage  they  offer  many 
advantages."^ 

Thoroughly  coated  ivory  points  and 
glasses  are  also  recommended.f  Dr.  Pott;]; 
speaks  highly  of  lymph  preserved  in  capil- 
lary tubes,  which  has  been  rendered  asep- 
tic by  equal  parts  of  a  three  and  one-half 
per  cent  solution  of  boracic  acid,  while 
lymph  treated  in  a  similar  manner  by  a  five 
per  cent  solution  of  carbolic  acid,  gave 
negative  results.§    After  filling  and  securely 

^  For  a  full  account  of  the  methods  of  employing  the  capil- 
lary tubes,  consult  Dr.  Husband,  as  quoted  by  Seaton  in  his 
Hand-book,  and  by  Heath  in  his  Minor  Surgery. 

f  To  insure  success  with  dry  lymph,  humanized  or  bovine,  re- 
quires that  the  material  upon'  which  it  is  stored  should  be  very 
heavily  charged. 

X  Jahrb.  f.  Kinderheilk,  xvii,  Bd.  2  u.  3  Heft. 

§  Pott  also  employed  a  salicylic  solution  (i  to  300).  Ac- 
cording to  the  Brit.  Med.  Jour.,  April  22,  1882,  Pott's  results 
coincide  with  the  more  extensive  experiments  of  Braidwood 
and  Vacher,  although  he  fails  to  give  his  methods  of  procedure. 
Braidwood  and  Vacher  have  insisted  on  the  great  importance 
of  using  special  instruments  for  each  set  of  experiments;  on 
the  necessity  of  testing  the  efficacy  of  the  vaccine  itself  before 
drawing  inferences  from  its  action  when  mixed  with  antiseptic 


OBTAINING  AND  STORING.  97 


sealing  capillary  tubes,  Dr.  Benoit,^  puts 
them  into  test  tubes  filled  with  lard,  so  as  to 
cover  them.  They  are  then  kept  in  a  cool 
place  till  used. 

The  humanized  crust,  the  usual  method  of 
preserving  vaccine  virus  employed  in  the 
United  States,  while  far  inferior  in  my 
judgment  to  other  preparations  of  vaccine, 
must  also  be  regarded  as  dangerous,   con- 

solutions;  on  the  influence  of  lengthened  contact  with  the  anti- 
septic, especially  in  the  case  of  carbolic  acid;  and  on  the  falsity 
connected  with  the  ordinary  manner  of  conducting  such  expe- 
riments by  inoculating  a  subject  on  the  one  arm  with  vaccine 
and  on  the  other  with  the  experimental  fluid.  In  their  second 
report  they  state  "that  a  saturated  solution  of  salicylic  acid 
does  not  impair  the  efficacy  of  the  vaccine  contagium;"  and 
that  a  saturated  solution  of  boracic  acid  "  impairs  the  vitality 
of  vaccine  contagium  little  if  at  all,  even  after  having  been 
kept  some  days  in  contact  with  the  contagium  particles."  On 
the  other  hand  (m  their  first  report)  their  conclusions  in  regard 
to  the  influence  of  carbolic  acid  on  the  vitality  of  vaccine  were, 
**(a),  that  the  immediate  inoculation  of  a  mixture  of  vaccine  and 
a  moderately  strong  solution  (i  to  20  aq.)  of  carbolic  acid  suc- 
ceeds in  a  certain  number  of  instances;  (b),  that  such  a  mix- 
ture, preserved  for  some  time,  seventeen  days  to  six  weeks, 
•fails  to  produce  vesicles,"  and  that  the  mixture  of  vaccine  with 
stronger  solutions  of  the  acid,  and  likewise  with  carbolate  of 
glycerine,  "destroys  the  efficacy  of  vaccine."  They  have  fur- 
ther distinctly  proven  that  antiseptics  in  the  gaseous  state  are 
much  more  potent  destroyers  of  the  vitality  of  vaccine  than 
are  such  in  solution  or  in  flnid  form.  These  reports  were  made 
to  the  Scientific  Grants  Commission  of  the  British  Medical 
Association. 
*  Lyon  Med.  June  5,  1S81. 


98  ESSENTIALS  OF  VACCINATION, 

taining  of  necessity  blood  cells  and  ne- 
crosed tissue.  In  England,  where  vacci- 
nation with  humanized  lymph  has  been  car- 
ried to  the  highest  perfection,  the  use  of  the 
crust  or  scab  is  condemned.  The  Ameri- 
can resort  to  the  crust  I  think  has  been  a 
matter  of  necessity  rather  than  choice,  but 
nevertheless  it  has  led  to  much  inferior  vac- 
cination. During  the  small-pox  epidemic  of 
ten  years  ago,  I  had  an  abundant  oppor- 
tunity of  satisfying  myself  that  Europeans 
generally  were  infinitely  better  vaccinated 
than  our  own  countrymen,  and  the  conclu- 
sion seems  justified  that  the  use  of  the  crust 
was  largely  responsible  for  our  inadequate 
protection. 


CHAPTER  IX. 

THE  OPERATION  OF  VACCINATING. 

General  Considerations. —  Simple  as 
the  operation  of  vaccinating  seems  to  be,  as 
a  matter  of  fact  it  requires  considerable 
technical  skill  in  its  performance,  and  an 
amount  of  theoretical  and  practical  knowl- 
edge of  the  subject,  which  is  but  rarely  ap- 
px^eciated  either  in  or  out  of  the  profession. 
"  If,"  declares  Mr.  Marson,  "a  little  operation 
— little  apparently  in  practice,  but  very  im- 
portant in  its  results, — well  performed,  can 
save  many  lives,  as  most  certainly  it  can, 
and  prevent  much  suffering  and  sorrow,  it 
should  surely  always  be  done  with  the  great- 
est care,  and  in  the  best  known  way.  The 
success  of  all  operations  depends  on  nice 
care  and  management.  Operations  for 
hernia  and  stone,  for  instance,  if  roughly, 
carelessly,  and  badly  done,  end  badly  ;  so  it 
is  with  vaccination;  and,  so  far  as  the  pub- 
lic is  concerned,  it  is  quite  as  objectionable 
to  them,  no  doubt,  to  die  of  small-pox  be- 
cause they  have  been   carelessly  and  badly 

09 


100  ESSENTIALS  OF  VACCINATION. 


vaccinated,  as  it  would  be  to  them  to  die  of 
hernia  or  of  stone,  because  the  operations 
for  these  complaints,  respectively,  had  been 
badly  performed.  In  the  latter  case  the  day 
of  retribution  would  occur  immediately;  in 
the  former,  unfortunately  for  its  correction, 
it  is  delayed  for  perhaps  twenty  years  or 
more ;  otherwise  it  would  soon  be  set  right. 
The  operation, as  an  operation,  has  not  been 
properly  estimated  from  the  first  introduc- 
tion of  it  in  England,  and  it  should  be  look- 
ed upon  as  a  blot  on  our  polity  that  vaccina- 
tion has  been  worse  performed,  generally,  in 
England,  its  birth  place,  than  in  any  country 
in  Europe."  ^' 

This  state  of  affairs  of  late  years  has 
undergone  great  improvement  in  England  ; 
but  I  doubt  if  there  is  a  civilized  land  where 
less  is  known  of  the  theory  and  practice  of 
vaccination  than  in  America.  The  reasons 
for  this  are  several.  There  is  no  doubt  that 
in  the  early  days  of  the  practice,  there  was 
a  greater  knowledge  of  the  subject  every- 
where ;  the  works  on  vaccination  of  Coxe 
and  others  show  that  it  was  fully  appreciated 

*Art.  Small-pox,   Reynold's  System  of   Med.,  p.  150,  Am. 
Edit. 


THE  OPERATION  OF  VACCINATING.      101 

and  understood  in  the  United  States.  In  the 
lapse  of  years,  however,  the  great  discovery 
became  so  much  a  matter  of  fact,  that  it  no 
longer  aroused  the  absorbing  interest  so 
universal  at  its  inception.  In  England,  an 
official  inquiry  made  in  1859,  developed  the 
fact,  as  stated  by  Seaton,  that  matters  of  the 
utmost  practical  importance,  which  had  been 
published  years  -and  years  before,  were  un- 
known to  a  large  majority  of  vaccinators  ; 
such,  for  instance,  as  the  proper  time  to  take 
lymph,  the  influence  of  the  quality  of  vacci- 
nation on  the  small-pox  death  rate,  etc.  In 
this  country,  where  there  is  no  national  rec- 
ognition of  the  practice,  where  vaccination 
from  arm-to-arm  is  comparatively  unknown, 
and  that  from  the  scab  very  nearly  general,  it 
results,  as  a  matter  of  course,  that  the  knowl- 
edge of  the  vaccinal  process,  necessitated  by 
the  English  and  continental  methods,  is  not 
widely  diffused."^  Druggists,  midwives,  and 
lay  persons  of  all  descriptions  finding  that 
medical  men  make  light  of  this  truly 
momentous  operation,  usurp  the  functions 
of  physicians  ;  and  the  consequence  of  the 
whole  matter  is  that  human  life  is  jeopard- 

*The  subject  is  criminally  neglected  in  our  medical  schools. 


102  ESSENTIALS  OF  VACCINATION. 


ized,  and  the  beneficent  science  and  practice 
of  vaccination  are  fallen  into  a  certain  amount 
of  disrepute. 

Vaccination  being  determined  upon,  there 
are  a  number  of  matters  to  be  duly  consid- 
ered before  the  operation  is  begun,  viz  : 

Condition  of  the  Person  to  be  Vac- 
cinated.—  Under  ordinary  circumstances 
the  individual  to  be  vaccinated  should  be 
in  good  health.  It  has  been  shown  that 
acute  febrile  processes  markedly  interfere 
with  the  normal  course  of  vaccinia,  but  on 
the  other  hand  certain  chronic  maladies 
offer  no  bar  to  vaccination.  I  am  satisfied 
from  personal  observation  that  the  presence 
of  syphilis  in  the  system  does  not  contra- 
indicate  the  operation.  The  same  experi- 
ence is  also  said  to  hold  good  for  scrofulous 
subjects.  Intestinal  and  cutaneous  affec- 
tions decidedly  contra-indicate  vaccination. 
It  is  well  known  that  Jenner  laid  much  stress 
on  the  fact  that  herpes,  eczema  and  in- 
tertrigo prevented  the  normal  reception  of 
the  vaccine  influence.  The  nomenclature 
of  the  eruptions  he  specified  may,  with  our 
present  dermatological  knowledge,  be  sub- 
ject to  some  criticism ;  but  I  am  fully  satis- 


THE  OPERATION  OF  VACCINATING.      103 


fied  in  my  own  mind,  that  the  general  rule 
as  to  avoiding  the  performance  of  vaccina- 
tion during  the  eruption  of  cutaneous  dis- 
eases, is  one  that  is  not  lightly  to  be  dis- 
regarded, although  there  are  undoubtedly 
many  exceptions  to  it.  Besides,  certain 
eruptions,  such  as  eczema  for  instance,  are 
certainly  aggravated  by  vaccination. 

It  is  said  that  pregnant  women  should  not 
be  subjected  to  vaccination  ;  but  the  opin- 
ions of  the  best  authorities  are  against  such 
conclusions.  Gast,  who  vaccinated  a  large 
number  of  pregnant  women  at  various  s^tages 
of  gestation,  did  not  observe  any  untoward 
results  from  the  practice. 

The  rules  as  to  the  selection  of  individ- 
uals to  be  vaccinated  are  necessarily  modi- 
fied by  circumstances;  if,  for  example,  a 
patient  be  exposed  to  the  risk  of  infection 
by  small-pox,  it  is  a  plain  duty  to  vaccinate 
in  spite  of  any  contra-indication. 

Age- — A  child  born  in  the  midst  of  small- 
pox contagion  should  be  vaccinated  at  once. 
I  have  seen  the  happiest  results  from  such  a 
procedure.  As  young  children  are  the  chief 
sufferers  from  small-pox — English  statistics 
showing  that  one-fourth  of  all   fatal  cases 


104  ESSENTIALS  OF  VACCINATION. 

occur  in  the  first  year  of  life — it  is  clear  that 
vaccination  should  not  be  delayed  beyond  a 
reasonable  period.  In  large  cities,  where 
variola  is  more  or  less  prevalent  at  all  times, 
vaccination  is  demanded  at  a  comparatively 
early  age — a  month  to  six  weeks, — provided 
there  is  no  good  reason  for  a  longer  delay.* 
It  may  be  stated  as  a  general  rule  that  when 
the  health  of  the  child  permits,  the  opera- 
tion should  be  performed  about  the  age  of 
three  months.  As  has  been  pointed  out,f  this 
time  of  life  is  particularly  suitable  from  the 
fact  that  it  anticipates  the  period  of  denti- 
tion, which  with  its  attendent  irritations  and 
derangements  might  seriously  interfere  with 
the  normal  development  of  the  vaccinia. 

Circumstances  which  Demand  the 
Immediate  Performance  of  Vaccina- 
tion.— It  has  already  been  stated  that  under 
danger  of  infection  no  age  should  be  exempt 
from  vaccination.  It  sometimes  happens 
that  small-pox  breaks  out  in  a  household 
where  there  are  a  number  of  unprotected  or 
imperfectly  protected  persons.  The  ques- 
tion then  arises:  Will  it  be  of  any  avail  to 
vaccinate  individuals  who  have  already  been 

*Seaton,  loc.  cit.,  p.  ii8.         f  Lindsley,  loc.  cit.,  p.  128. 


THE  OPERATION  OF  VACCINATING.       105 


exposed,  for  a  greater  or   lesser  period,  to 
the  variolous  contagion  ? 

This  matter  has  been  so  well  put  —  and  in 
a  manner  that  so  exactly  coincides  with  what 
my  own  experience  leads  me  to  believe  to  be 
true — by  Seaton  and  Marson,  that  I  am  con- 
strained to  present  their  observations  as 
fully  and  literally  as  space  will  allow.  At 
once  and  without  any  delay,  says  Seaton,^ 
the  vaccination  of  all  such  persons  should 
be  performed  ;  the  loss  of  a  day  may  be  the 
sacrifice  of  a  life.  It  does  not  follow,  he 
continues,  that  because  a  person  has  been 
exposed  to  the  infection  of  small-pox,  he 
has  therefore  received  infection,  and  the 
vaccination  may  be  in  time  to  prevent  the 
infection  altogether ;  but,  supposing  that  be- 
fore the  vaccination  is  performed  the  vari- 
olous infection  has  actually  been  taken  up 
by  the  system,  unless  that  infection  have  so 
far  got  the  start  that  the  small-pox  symp- 
toms appear  before  the  vaccination  reaches 
the  stage  of  developed  areola,  the  vaccine 
process  will  nevertheless  either  prevent  or 
modify  the  small-pox  eruption  ;  if,  on  the 
other  hand,  the  variola  manifest  itself  before 

*  Handbook  of  Vaccination,  p.  iig. 


106  ESSENTIALS  OF  VACCINATION. 

the  vaccination  has  reached  its  protective 
stage,  the  stage  of  areola,  the  vaccination, 
though  it  will  have  done  no  good,  will 
have  done  no  harm  —  the  small-pox  will  go 
on  as  though  it  never  had  been  performed. 
As  the  incubative  period  of  small-pox  is 
twelve  days,  while  the  time  required  to 
bring  the  vaccinia  to  the  stage  of  areola  is 
only  nine  days,  vaccination  performed  any 
time  within  the  first  three  days  will  reach 
areola  soon  enough  to  produce  its  protect- 
ive pov/er;  after  this,  whatever  the  local 
success  of  the  vaccination,  no  constitutional 
effects  will  be  imparted.  The  late  Mr.  Mar- 
son,  than  v/hom  no  one  could  speak  with 
greater  authority,  put  the  matter  in  this 
way  :  ^  Suppose  an  unvaccinated  person  to 
inhale  the  germ  of  variola  on  a  Monday; 
if  he  be  vaccinated  as  late  as  the  following 
Wednesday,  the  vaccination  will  be  in  time 
to  prevent  small-pox  being  developed  ;  if  it 
be  put  off  until  Thursday,  the  small-pox 
will  appear,  but  will  be  modified ;  if  the 
vaccination  be  delayed  until  Friday,  it  will 
be  of  no  use,  it  will  not  have  had  time  to 

*  Small-pox,  Reynold's  Syst.  Med.  vol.  i,  p.  154,  Am.  Edit. 


THE  OPERATION  OF  VACCINATING.       107 

reach  the  stage  of  areola,  the  index  of 
safety,  before  the  illness  of  small-pox  begins. 
The  idea  which  I  believe  was  first  suggest- 
ed by  Eichhorn,*  and  now  and  again  revived, 
that  small-pox  could  be  modified  by  the 
free  inoculation  of  vaccine  matter  after  the 
disease  had  developed,  does  not  seem  to  me 
tenable,  whether  considered  from  the  stand- 
point of  theory  or  actual  experience.  In 
quite  a  number  of  observations  made  by 
myself  upon  this  subject,  I  do  not  remember 
to  have  seen  the  slightest  influence  exerted 
upon  the  variola  by  the  vaccine  inoculation. 
If  vaccinia  and  variola  are  identical  in  na- 
ture, as  I  believe  they  are,  such  practice 
would  be  highly  unscientific. 

Performance  of  the  Operation. — The 

proper  performance  of  vaccination  requires 
a  consideration  of  the  best  methods  of  pre- 
paring the  virus  for  insertion,  and  the  best 
way  of  inserting  it  under  the  epidermis. 

A.  Pi^eparation  of  the  virus, —  If  liquid 
lymph  be  used,  whether  direct  from  the  hu- 
man or  bovine  vaccinifer  or  preserved  in 
tubes  or  otherwise,  no  preparatory  steps  are 
necessary  other  than  taking  it  up  on  a  clean 

*Rayer  on  Dis.  of  Skin.     Am.  Edit.,  1S45,  p.  157. 


108  ESSENTIALS  OF  VACCINATION, 

instrument,  and  inserting  it  into  the  cutis  in 
the  manner  that  has  been  determined  upon. 
If  the  vaccine  crust  be  employed  a  small 
portion  should  be  carefully  reduced  to  pow- 
der and  then  made  into  paste  with  water. 
The  solution  thus  prepared  should  be  used 
with  a  free  hand.  Lymph  that  has  been 
preserved  by  storing  on  quill  or  ivory  points 
or  between  glasses,  requires  a  certain  amount 
of  preliminary  care  before  insertion;  it  is 
necessary  that  the  virus  be  rendered  liquid, 
''  revived,"  before  insertion  is  attempted. 
This  is  best  done  with  a  minute  quantity  of 
cold  water.  This  precaution  is  doubly 
necessary  when  bovine  virus  is  employed. 

B.  Methods  of  Insei^lzng  the  Virus, — The 
main  object  in  view  in  vaccinating  is  to  see 
that  virus  is  applied  in  such  a  way  that  it 
will  be  most  readily  absorbed  into  the  sys- 
tem. To  this  end  various  methods  of  in- 
sertion have  been  recommended  and  prac- 
ticed. The  two  most  common  modes  of  pro- 
cedure are  by  puncture  and  scarification."^' 

If  puncture  be  determined  upon,  the 
patients    arm    should  be    grasped    by    the 

*  Application  of  a  vesicant  and  by  hypodermic  injection  have 
also  been  mentioned,  but  are  not  to  be  recommended. 


THE  OPERATION  OF  VACCINATING.      109 

left  hand  of  the  operator,  so  as  to  render 
the  skin  tense,  and  a  sharp,  perfectly  clean, 
well-charged  lancet  should  be  introduced  by 
valvular  puncture,  from  above  downward, 
so  that  the  lymph  may  gravitate  into  the 
wound.  The  lancet  should  be  held  at  an  an- 
gle of  about  45  degrees,  and  made  to  pene- 
trate the  cutis.  It  is  recommended  that 
when  puncture  is  employed  it  is  advisable 
to  make  each  puncture  a  double  one.  // 
A  modification  of  the  puncture  is  by  tattoo- 
ing, ^jh  Another  modification  of  puncture  is 
by  first  smearing  the  lymph  over  the  arm 
and  then  ripping  up  the  cuticle  with  the 
point  of  a  not  very  sharp  lancet.  The 
m.ethod  by  scarification  consists  in  making 
a  number  of  single  or  double  scratches,  // 
or  abrading  the  skin  by  a  series  of  closely 
set  parallel  lines,  I////  or  by  a  further  series 
of  cross  scratches.  ^  Indeed,  the  cuticle 
may  be  abraded  in  any  way  that  Vv^ill  safely 
and  thoroughly  expose  a  sufficient  absorb- 
ing surface.  The  favored  mode  of  operat- 
ing in  this  country  and  latterly  in  England, 
is  by  the  more  certain  and  effective  method 
of  scarification.  It  is  undoubtedly  to  be 
preferred  to  all  other  procedures. 


no  ESSENTIALS  OF  VACCINATION. 


I  do  not  believe  that  any  special  contriv- 
ances for  effecting  vaccination  are  necessary; 
a  good  lancet  that  is  kept  scrupulously 
clean,  and  used  for  no  other  purpose,  being 
all  sufficient ;  but  my  own  preference  is  to 
use  for  each  case  a  separate  ivory  point  or 
quill  upon  which  the  lymph  is  stored. 

If  a  lancet  be  employed  it  should  be 
thoroughly  cleansed  before  being  used  upon 
another  person.  The  chief  points  in  suc- 
cessful vaccination,  especially  animal  vac- 
cination, are  to  first  revive  the  lymph  and 
then  to  rub  it  gently  but  thoroughly  into 
the  abraded  surface,  and  above  all  to  use 
it  with  a  lavish  hand.*     ' 

Vaccinations  are  generally  performed  in 
too  hurried  a  manner;  on  the  contrary  the 
vaccinator  should  proceed  with  the  utmost 
care  and  deliberation.  My  habit  is  to  work 
the  lymph  into  the  wound  until  dry,  and  not 
leave  the  absorption  to  chance.  In  vacci- 
nating we  should  endeavor  to  go  deep  enough 
to  cause  a  slight  oozing  but  not  a  flow  of 
blood,  and  any  superfluous  blood  should  be 
wiped  away  before  applying  the  lymph.    The 

*Thc  habit  of  using  one  point  or  quill  for  two  persons  is 
both  filthy  and  dangerous. 


THE  OPERATION  OF   VACCINATING,      111 

usual  place  selected  for  vaccination  is  upon 
the  left  arm  at  the  insertion  of  the  deltoid 
and  along  its  posterior  border.  The  several 
punctures  or  abrasions  should  be  made  at 
some  little  distance  from  each  other. 

It  has  been  found  by  abundant  observation 
that  both  the  quality  and  the  quantity  of  the 
vaccination  bear  a  vital  relation  to  subsequent 
protection  from  small-pox.  Marson's  famous 
table  giving  the  results  of  his  observations 
on  nearly  5,000  post-vaccinal  cases  of  vari- 
ola, which  occurred  in  the  twenty  years  — 
1836  to  1855,  inclusive  —  testify  in  a  strik- 
ing manner  to  the  truth  of  this  assertion  : 

No.  of  Deaths  Per  Cent. 
Classification  of  Patients  Affected  in  Each  Class  Re- 

With  Small-Pox.  spectively. 

1.  Unvaccinated 35 

2.  Stated  to  have  been  vaccinated,  but 

having  no  cicatrix 23.57 

3.  Vaccinated — 

a.  Having    one    vaccine    cicatrix     .  7.73 

b.  Having  two  vaccine  cicatrices     -  4.70 

c.  Having  three  vaccine  cicatrices    -  1.95 

d.  Having    four    or    more    vaccine 

cicatrices      - 0.55 

a.  Having  well-marked  cicatrices     -  2.52 

/5.  Having    badly-marked    cicatrices  8.82 

4.  Having   previously  had  small-pox     .  19 

It  will  therefore  be  seen  that  not  only 


112  ESSENTIALS  OF  VACCINATION, 

should  the  vaccination  be  well  done,  but 
the  system  should  at  the  same  time  be  thor- 
oughly infected. 

The  practical  question  then  arises,  How 
many  punctures  should  be  made,  if  that 
be  the  method  followed,  or  what  should 
be  the  number  or  area  of  the  abrasions  if 
scarification  be  practised  ?  Seaton  says 
that  in  vaccinating  by  puncture  not  less 
than  five  should  be  made  at  a  distance 
of  one-half  inch  from  each  other.  Marson 
always  made  six  punctures.  In  some  coun- 
tries ten  to  sixteen  punctures,  five  to  eight 
on  each  arm,  are  advised.  Of  course,  where 
abrasions  of  the  cuticle  are  resorted  fo,  the 
area  of  the  inoculation  is  to  be  considered 
rather  than  the  number  of  individual  marks 
to  be  produced.  As  pertinent  to  this  point  I 
shall  quote  from  a  paper  by  Dr.  J.  B.  Rus- 
sell, of  Glasgow.  ''  The  number  of  vaccine 
marks  can  have  no  meaning,  excepting  so 
far  as  they  indicate  in  a  general  way  the 
quantity  of  lymph  introduced  into  the  sys- 
tem. It  cannot  be  that  the  same  quantity 
of  lymph  introduced  into,  four  spots  success- 
fully, confers  more  immunity  than  if  intro- 
duced into  one  spot  successfully,  or  that  by 


THE  OPERA  TION  OF  VA  CCINA  TING.      1 1 3 

dividing  a  cicatrix  into  four,  its  productive 
value  is  increased.  Hence,  I  am  inclined  to 
think  that  the  local  and  permanent  phenom- 
ena which  would  best  indicate  the  quantity 
of  lymph  introduced,  and  consequently  show 
even  more  striking  relations  to  the  mortality, 
would  be  the  superficial  area  of  good  vaccine 
cicatrices.  It  seems  evident  from  Marson's 
description  of  his  mode  of  vaccination  that 
he  would  produce  four  good  vaccine  marks 
whose  united  area  would  probably  little  ex- 
ceed one  vaccine  mark  such  as  is  left  by  the 
operation  as  practised  at  our  public  vaccine 
stations  at  Glasgow." 

It  is  stated  by  Dr.  Bridges,  in  an  official 
report  to  the  English  Parliament,  that  the 
vaccination  department  now  requires  as  a 
test  of  efficient  vaccination,  that  the  united 
area  of  the  cicatrices  should  amount  to  half 
a  square  inch.  It  is  no  doubt  true  that 
vaccination  done  with  bovine  virus  does  not 
require  the  amount  of  local  effect  made 
necessary  by  the  use  of  long  humanized 
vaccine  lymph^';  but  as  the  reaction  from 

*  Dr.  Cameron  has  published  tables  showing  that  small-pox 
mortality  has  progressively  increased  in  the  best  class  of  cases 
— cases  amply  vaccinated  and  with  good  scars — under  the  use 
of  long-humanized  lymph. 


114  ESSENTIALS  OF  VACCINATION, 

one  abrasion  is  no  greater  than  from  three, 
safety  and  efficiency  would  demand  the 
larger  number  under  any  circumstances,  or 
their  equivalent  in  area. 

Inspection  of  Results. — Vaccination 
having  been  duly  and  properly  performed, 
it  is  the  duty  of  the  medical  man  to  see  that 
the  disease  thus  produced  runs  a  normal 
and  typical  course.  Nothing  could  be  more 
unfortunate  than  an  inefficient  primary  vac- 
cination ;  for  a  false  security  is  thereby 
engendered,  which  may  not  only  be  disas- 
trous to  the  individual,  but  will  necessarily 
bring  the  cause  of  vaccination  into  disrepute. 
The  subsequent  course  of  a  vaccination 
should  be  watched  with  the  same  care  and 
anxiety  as  the  after  treatment  of  any  of  the 
major  operations  of  surgery.  The  physician 
should  impress  upon  his  patient  the  necessity 
for  this  watchfulness,  and  explain  that  a  sore 
arm  does  not  necessarily  mean  protection 
against  small-pox ;  but  that  vaccinia  runs  a 
certain  typical  course,  the  various  stages  of 
which  can  only  be  properly  appreciated  by 
expert  knowledge.  The  English  vaccination 
laws  require  that  a  vaccination  should  al- 
ways be  duly  inspected,  the  period  for  such 


THE  OPERA  TION  OF  VA  COIN  A  TING.       115 

inspection  being  established  at  the  eighth 
day.  Seaton  urges  that  the  patient  should 
also  be  seen  on  the  eleventh  and  twelfth 
days,  so  that  we  may  be  assured  that  the 
stage  of  areola,  "  the  index  of  safety/'  has 
been  passed  in  a  satisfactory  manner.  At 
any  rate  the  vaccinator  will  have  done  but 
half  his  duty,  who  fails  to  have  his  patient 
return  on  at  least  the  day  week  from  the 
day  of  vaccination. 


CHAPTER  X. 

EXAMINATION     OF     THE    OBJECTIONS    TO 
VACCINATION. 

General  Considerations. —  It  seems 
scarcely  credible  to  the  well-informed  mind 
that  any  one  should  question,  or  even  for  a 
moment  doubt,  the  rich  blessing  that  the 
practice  of  vaccination  has  conferred  upon 
the  world ;  yet  we  hear  it  gravely  charged 
that  vaccination  does  not  afford  protection 
against  small'pox,  and  that  its  inoculation 
has  entailed  innumerable  miseries  upon  the 
human  race. 

All  that  is  claimed  for  vaccination  by  its 
warmest  advocates  is  that,  '*  diily  aiid  effi- 
ciently performed^'  it  will  either  altogether 
prevent  or  materially  modify  small  pox,  and 
that  by  the  exercise  of  ordinary  skill  and 
care,  the  operation  will  not  be  followed  by  any 
harmful  consequences.  The  space  at  com- 
mand forbids  the  consideration  of  the  many 
wild  and  baseless  assertions  which  have  been 
uttered  by  that  class  of  people  opposed  to 
everything  established.      With  the  general 

116 


OBJECTIONS  TO  VACCINATION,  117 

Statement,  however,  that,  after  nearly  a  cen- 
tury of  severest  trial,  vaccination  stands 
to-day  an  assured  fact  in  the  estimation  of  the 
scientific  world,  I  shall  proceed  to  consider 
the  question  from  the  only  two  stand-points 
at  all  worthy  of  serious  attention,  viz  :  Does 
efficient  vaccination  and  re-vaccination  pro- 
tect against  small-pox?  and,  Does  the  opera- 
tion of  vaccination  introduce  into  the  system 
other  diseases  than  vaccinia? 

Protection  Afforded  by  Vaccination 
against  Small-Pox. — The  present  gener- 
ations have  no  conception  of  the  horrors  of 
small-pox  as  it  existed  uncontrolled  by  vac- 
cination. Macaulay,  the  great  English  his- 
torian, comparing  the  ravages  of  small-pox 
at  the  close  of  the  17th  century  with  the 
ravages  of  the  plague,  says :  "  The  havoc 
of  the  plague  had  been  far  more  rapid,  but 
the  plague  had  visited  our  shores  only  once 
or  twice  within  living  memory,  but  the  small- 
pox was  aKvays  present,  filling  the  church- 
yards with  corpses,  leaving  on  those  whose 
lives  it  spared  the  hideous  traces  of  its 
power,  turning  the  baby  into  a  changeling  at 
which  the  mother  shuddered,  and  making 
the  eyes  and  cheeks  of  the  betrothed  maiden 


118  ESSENTIALS  OF  VACCINATION, 


objects  of  horror  to  the  lover."  The  dis- 
ease attacked  the  mighty  as  well  as  the 
lowly;  it  spared  neither  the  palace  nor  the 
hovel  Mary,  the  wife  of  William  III,  died 
of  small-pox,  as  did  his  father  and  mother, 
his  uncle,  the  duke  of  Gloucester,  and  his 
cousins,  the  eldest  son  and  youngest  daugh- 
ter of  James  II.  In  the  court  of  Austria, 
Joseph  I  succumbed  to  it,  to  which  list  may 
be  added  "  in  the  course  of  the  i8th  century, 
besides  him,  two  empresses,  six  archdukes 
and  duchesses,  an  elector  of  Saxony  and  the 
last  elector  of  Bavaria.''  A  dauphin  of 
France  died  of  variola  in  1711  and  a  king 
of  France  in  1770,  besides  a  queen  of 
Sweden  in  1741  and  an  empress  of  Russia 
in  1727.  Such  deaths  occurring  at  the  pres- 
ent day  would  fill  the  world  with  horror 
and  consternation.  Those  who  escaped 
with  their  lives  were  maimed  and  disfio^ured. 
Large  numbers  of  the  deaf  and  blind  owed 
their  misfortune  to  small-pox.  The  annual 
mortality  of  small-pox  in  England  was  about 
3,000  to  every  1,000,000  of  inhabitants.  In 
France  30,000  persons  perished  annually  of 
variola.  It  is  stated  that  within  the  years 
1783-99  one-tenth  of  the  total  mortality  at 


OBJECTIONS  TO  VACCINATION,  119 

Berlin  was  due  to  small-pox.  In  a  single 
year,  about  1560,  De  la  Condamine  declares 
that  it  destroyed  in  the  province  of  Quito 
more  than  100,000  Indians.  In  1721,  one- 
half  the  population  of  Boston  was  attacked 
with  small-pox,  one-thirteenth  of  which  died. 

Such  facts  and  figures  could  be  largely 
multiplied  from  accurate  historical  data,  but 
there  is  little  dispute  about  their  correctness  ; 
the  deductions  to  be  drawn  from  them  are 
questioned  by  the  so-called  anti-vaccinators. 

Small-pox  is  to-day,  among  unprotected 
persons  and  communities,  as  virulent  and 
destructive  as  in  the  past.  We  have  numer- 
ous records  of  epidemics  among  unvaccinat- 
ed  people,  which  show  that  the  disease  has 
lost  none  of  its  malignancy. 

In  seeking  to  inform  ourselves  as  to  the 
protection  from  small-pox  afforded  by  vacci- 
nation, it  should  never  be  forgotten  that  the 
practice  gained  its  first  foothold  in  public  and 
medical  estimation  through  the  experimen- 
tu7n  cruets  furnished  by  direct  inoculation. 
So  confident  were  the  early  disciples  of  vac- 
cination as  to  its  protective  influence  that 
they  did  not  hesitate  to  inoculate  with  small- 
pox virus,  and  otherwise  expose  to  its  infec- 


120  ESSENTIALS  OF   VACCINATION. 

tion,  those  who  had  been  successfully  vacci- 
nated. Nearly  all  of  the  early  cases  were 
thus  tested. 

Although  it  has  been  shown  in  another 
section  that  the  prophylactic   influence  of 
vaccination   is    not    so   great  as   in   former 
years,  the  causes  for  this  diminution  have 
also  been  indicated  and  its  remedy  pointed 
out;   but  even  with    this  decay  of  vaccine 
influence,  together  with  the   careless  man- 
ner   in    which    the    operation    is   generally 
performed,    universal    and    extended   expe- 
rience furnishes  an  overwhelming  argument 
for  the  practice,  and    the   farther  back  we 
extend  our  inquiries  the  more   convincing 
are  the  proofs.     For  example,  in  Sweden,  be- 
fore the  introduction  of  vaccination,  the  an- 
nual death  rate  from  small-pox  was  2,050  out 
of  every  million  of  population,  while  during 
the  40  years,  1810-50,  it  was  but  158;   in 
Westphalia,  where  the  deaths  from  small- 
pox were  formerly   2,643    P^^   million,  be- 
tween   the  years    1816-50   it    fell    to    114; 
in   Bohemia,  Moravia,  and  Austrian  Silesia 
it   was    reduced    from    4,000    to    200;    in 
Copenhagen    from    3,128    to    286;    and    in 
Berlin  from   3,422   to    176.      In  Annspach, 


OBJECTIONS  TO  VACCINATION,  121 

Bavaria,  with  a  population  of  over  300,000, 
all  thoroughly  vaccinated,  no  deaths  from 
small-pox  occurred  between  the  years  1810- 
18.  During  Mr.  Marson's  term  of  thirty 
years  in  the  London  Small-pox  Hospital, 
15,000  cases  of  variola  were  under  his  charge, 
and  his  statistics  prove  that  the  unvacci- 
nated  died  at  the  rate  of  thirty-five  per  cent, 
while  the  presumably  vaccinated  died  at 
the  rate  of  6^  per  cent. 

When  small-pox  prevails  in  a  community 
where  some  are  protected  and  others  unpro- 
tected, the  influence  of  vaccination  is  most 
strikingly  shown.  Thus  in  the  Island  of 
Bombay,  for  the  years  1848-53,  the  small- 
pox deaths  among  the  general  population, 
the  majority  of  which  was  unprotected, 
were  5.8  per  cent  of  the  mortality  from 
all  causes;  but  among  the  European  resi- 
dents, mostly  protected  by  vaccination,  the 
small-pox  deaths  were  for  the  same  peri- 
ods but  I  per  cent  of  the  deaths  from  all 
causes.  In  observations  made  for  twenty- 
one  years  on  four  millions  of  people  in  Bo- 
hemia, it  was  discovered  that  the  death- 
rate  among  vaccinated  persons  who  con- 
tracted small-pox  was  ^-^-^  per  cent,  while 


122  ESSENTIALS  OF  VACCINATION. 

on  the  other  hand,  the  mortality  among  the 
unvaccinated  who  contracted  small-pox  was 
29!^  per  cent.  » 

Dr.  Buchanan,^  Medical  Ofificer  of  the 
Local  Government  Board  (England),  has 
published  a  memorandum,  dated  June  3, 
1 88 1,  with  the  object  of  showing  the  pro- 
portionate prevalence  of  small-pox,  and  the 
proportionate  mortality  caused  by  it  among 
the  vaccinated  and  unvaccinated,  respect- 
ively. The  Registrar-General  had  for  the 
previous  year  recorded  all  the  information 
obtainable  on  the  subject,  returning  only 
the  cases  certified  to  by  registered  practi- 
tioners, and  dividing  the  London  mortality 
returns  into  three  classes,  namely,  the  vac- 
cinated, the  unvaccinated  and  those  cases 
where  it  was  not  stated  if  the  deceased  had 
been  vaccinated  or  not.  It  was  shown  that 
there  died  in  London  from  variola  during 
the  52  weeks  1,532  persons  of  all  ages,  of 
whom  325  were  certified  to  have  been  vac- 
cinated, 637  as  not  vaccinated,  and  570 
belonging  to  the  ''  not  stated  "  class.     In  the 

*  Med.  Times  and  Gaz.,  June  i8,  1881.  The  memorandum 
was  pubVished  as  a  parliamentary  paper.  The  facts  above  are 
taken  from  an  editorial  in  the  journal  quoted. 


OBJECTIONS  TO  VACCINATION,  123 

tabulated  statement  which  follows,  the  ''  not 
stated  "  deaths  are  set  aside.  Dr.  Buchanan 
gives  the  grounds  upon  which  he  calculates 
that  the  vaccinated  persons  of  all  ages  liv- 
ing in  London  in  the  twelve  months  con- 
cerned were  3,620,000,  and  the  unvaccinated 
of  all  ages  190,000  in  number,  and  he  deals 
with  the  mortality  from  small-pox  in  these 
two  classes  respectively.  He  also  examines 
in  the  same  way  the  small-pox  death-rate  of 
persons  under  twenty  years  of  age,  and  of 
those  under  five  years.  The  results  are  as 
follows : 

Co7nparative  small-pox  death-rates  among 
Londone7^s,  vaccinated  and  ttnvaccinated  re- 
spectively, for  the  ^2  weeks  ended  May  2g, 
188 1  : 

Death-rate  of  people        Per  million  of  each  ajre        ^^^  "}^"i^"  °^  ^^^^  ^^^ 
of  subioined  ages.  of  the  vaccinated  class.  ^^  nated  clasT*" 

All  ages       .      _      .      .     90 3,350 

Under  twenty  years     -61  4,520 

Under  five  years      -      -40^      ._      .      _      _       5j95o 

In  order  to  view  the  question  from  all 
possible  sides.  Dr.  Buchanan  also  adds  that 
if  it  could  be  imagined  that  all  the  ''  not 
stated "  deaths  were  of  unvaccinated  per- 
sons, the  respective  rates  of  all-age  small- 
pox mortality  would  be    90  for  the   vacci- 


124  ESSENTIALS  OF  VACCINATION, 

nated  and  6,350  for  the  unvaccinated;  for 
those  under  20  years  of  age  the  rates  would 
be  61  for  the  vaccinated,  and  7,428  for  the 
unvaccinated,  and  for  those  under  5  years, 
40^  for  the  vaccinated,  and  9,300  for  the 
unvaccinated;  while,  on  the  other  hand,  if  it 
could  be  imagined  that  all  the  '*  not  stated  " 
deaths  were  of  vaccinated  persons,  the 
rates  of  all-age  mortality  would  become  247 
for  the  vaccinated  and  3,350  for  the  unvac- 
cinated ;  under  20  years  of  age  260  for  the 
vaccinated  and  4,520  for  the  unvaccinated; 
and  among  those  under  5  years  of  age,  334 
for  the  vaccinated  and  5,950  for  the  unvac- 
cinated. Thus,  from  whatever  standpoint 
the  matter  is  examined,  the  advantage  of 
the  vaccinated  over  the  unvaccinated  is 
made  manifest,  although  this  advantage 
would  have  been  exhibited  in  a  still  clearer 
way  if  the  Registrar-General's  returns  had 
noted  the  character  of  vaccinations,  and  the 
thoroughness  with  which  they  had  been  per- 
formed.* 

*The  Med.  Times  and  Gaz.,  commenting  editorially  on  the 
facts  and  figures  given  above,  says:  "  It  will  be  noticed  that 
the  table  given  above  shows  that  among  the  vaccinated  the  rate 
of  mortality  from  small-pox  is  half  as  much  again  where  per- 
sons up  to  20  years  of  age  are  included  as  it  is  in  children 


OBJECTIONS  TO    VACCINATION,  125 


By  thorough  vaccination  is  meant  a  pri- 
mary vaccination  *'  duly  and  efficiently  "  per- 
formed, both  as  to  quality  and  quantity, 
and  no  less  efficient  revaccination. 

Nothing  short  of  this  is  to  be  considered 
adequate  vaccination,  and  any  figures  pur- 
porting to  show  the  failure  of  vaccination  as 
a  preventive  of  small-pox  are  valueless 
unless  it  can  be  proved  that  these  prerequi- 
sites of  efficient  prophylaxis  have  been  fully 
carried  out. 

Marson's  table,  already  quoted,  shows  the 
value  of  efficient  vaccination  in  a  way  that 
cannot  be  questioned.  Observations  made 
by  Drs.  Seaton  and  Buchanan  during  the 
small-pox  epidemic  in  London,  in  1863,  on 

under  5  years;  and  that  the  all-age  mortality  is  again  half  as 
much  again  as  it  is  where  only  persons  up  to  20  are  taken. 
Among  the  tinvacchiatcd,  on  the  contrary,  the  mortality-rate  is 
at  its  maximum  during  childhood,  and  diminishes  as  life 
advances.  The  explanation  of  this  appears  to  be  that  the  pro- 
tection afforded  to  the  vaccinated  by  vaccination  diminishes 
with  age,  while  among  the  unvaccinated  the  liability  to  death 
from  small-pox  diminishes  vv^ith  age;  they  have  had  small-pox, 
perhaps,  ^nd  recovered  from  it,  or  they  are  less  exposed  to 
it,  or  v/ith  advancing  age  the  susceptibility  to  the  contagion 
diminishes."  These  figures  demonstrate  in  an  incontroverti- 
ble way  the  value  of  infant  vaccination,  and  the  necessity  for 
revaccination.  Some  tables  published  in  the  Boston  Medical 
and  Surgical  Jonrnal,  February  10,  1881,  are  worth  consulting 
in  this  connection. 


126  ESSENTIALS  OF  VACCINATION, 

Upwards  of  50,000  school  children,  exhibit 
from  another  point  of  view  the  necessity  of 
having  regard  to  the  efficiency  of  the  vaccina- 
tion in  estimating  the  protection  which  it  is 
capable  of  affording.  They  give  the  follow- 
ing results  of  their  inspection. 

Some  of  the  children  examined  had  never 
been  vaccinated ;  the  large  majority  had 
been  vaccinated  in  various  manners  and 
degrees.  Of  every  thousand  without  any 
mark  of  vaccination  they  found  that  no  fewer 
than  360  had  scars  of  small-pox;  while  of 
every  thousand  who  presented  evidence  of 
vaccination  only  1.78  had  such  traces. 
Upon  further  classification  as  to  the  kind  of 
vaccination  they  noted  the  following  facts  : 

Classification  Proportion  Marked  With 
of  Small-pox  Per  locx) 

Children  Children  in  Each 

Examined.  Class  Respectively. 

1.  Having  no  vaccine  marks     ^     .     .     .     .     360 

2.  Vaccinated — 

a.  Having  one  vaccine  cicatrix     .  .      „  6.80 

b.  Having  two   vaccine    cicatrices  -      -  2.49 

c.  Having  three  vaccine  cicatrices  .      -  1.42 

d.  Having   four   or    more    vaccine  cica- 

trices              0.67 

X,  Having  cicatrix  or   cicatrices  of  bad 

quality 7.60 

y.  Having  cicatrix  or  cicatrices  of  tolera- 
ble  quality 2.35 

z.  Having   cicatrix    or  cicatrices    of    ex- 
cellent quality 1.22 


OBJECTIONS  TO  VACCINATION.  127 

On  taking  the  extremes  it  appeared  that 
of  children  having  four  or  more  perfect 
vaccine  marks,  only  0.62  per  thousand  had 
any  trace  of  small-pox,  while  of  those  who 
had  a  single  bad  mark,  19  per  thousand  were 
disfigured  by  small-pox  scars.  They  con- 
clude, therefore,  that  as  against  small-pox 
of  such  extent  as  to  leave  any  traces,  the 
best  vaccination  had  been  upwards  of  thirty 
times  as  protective  as  the  worst.  In  ad- 
dition. Dr.  Seaton  declares  that  the  numer- 
ical statement  is  far  from  expressing  the 
whole  difference ;  for  while  the  small-pox  left 
but  very  slight  traces  on  those  who  had  been 
vaccinated,  and  especially  those  who  had 
been  well-vaccinated,  a  large  proportion  of 
the  unvaccinated  were  seriously  disfigured, 
and  in  some  instances  the  disease  had 
caused  permanent  blindness  or  deafness."^ 

It  is  not  now  claimed  that  a  single  vacci- 
nation is  a  sufficient  protection  against 
small-pox  for  the  rest  of  life — repeated 
observation  has  taught  the  necessity  for  re- 
vaccination  at  stated  intervals ;  but  syste- 
matic revaccination,  thoroughly  performed, 
almost  completely  extinguishes  the  suscepti- 

*  Reynold's  System  Med.,  p.  169,  Am.  Edit. 


128  ESSENTIALS  OF  VACCINATION. 

bility  of  small-pox  in  a  large  number  of  peo- 
ple. 

Nothing  more  clearly  exhibits  the  efficacy 
of  proper  vaccination  and  revaccination  — 
it  is  difficult  to  dissociate  the  two  —  than 
the  medical  history  of  the  Franco-Prussian 
war.  At  that  time,  according  to  Dr.  Welch,* 
small-pox  prevailed  to  an  alarming  extent, 
and  both  armies  were  fully  exposed  to  the 
contagion  ;  but  the  German  mortality  was 
only  263  men,  while  the  French  loss  w^as 
23,468,  although  the  latter  army  was  at  no 
time  more  than  half  the  size  of  the  former. 
The  explanation  of  the  marked  difference 
in  the  small-pox  mortality  of  the  two  armies 
lies  in  the  fact,  as  pointed  out  by  Dr.  Welch, 
that  in  no  country  is  vaccination  carried  on 
with  greater  care  and  thoroughness  than  in 
Germany.  Almost  every  infant  is  vaccinated 
within  a  year  after  birth,  and  revaccination 
is  usually  performed  about  the  twelfth  year. 
Every  soldier  is  vaccinated  upon  entering 
the  army,  and  if  the  operation  fail  it  is 
repeated  again  and  again  until  some  result 
is  obtained,  or  the  surgeon  is  satisfied  of 
vaccinal    insusceptibility.       In    the    French 

*Phila.  Med.  Times,  August.  13,  1881. 


OBJECTIONS  TO  VACCINATION.  129 

army  neither  vaccination  nor  revaccination 
was  compulsory  ;  in  fact,  the  whole  military 
establishment  was  practically  unprotected 
from  variola. 

Mr.  Marson  states  that  very  few  per- 
sons have  been  admitted  into  the  London 
Small-pox  Hospital  who  acknowledged  to 
an  effectual  revaccination,  and  these  few 
have  had  small-pox  in  a  very  mild  form. 
For  over  thirty  years  he  revaccinated  all 
the  nurses  who  came  to  live  in  the  hospital, 
and  who  had  not  had  small-pox,  and  not 
one  of  them  contracted  the  disease  during 
the  stay  there.  Dr.  Welch  says  that  very 
few  persons  have  ever  been  admitted  into 
the  hospital  under  his  charge  who  presented 
evidence  of  having  been  successfully  revac- 
cinated, and  these  few  have  had  the  disease 
in  so  mild  a  form  that  death  has  never  oc- 
curred among  them.  During  the  last  ten 
years  no  person  entering  the  hospital  in  an 
official  capacity,  physicians,  nurses,  etc.,  who 
had  taken  the  precaution  to  be  revaccinated, 
has  contracted  small-pox,  while  a  few  in 
whom  revaccination  had  been  omitted  have 
taken  it. 

Similar  facts  and  statistics  could  be  multi- 


130  ESSENTIALS  OF  VACCINATION, 

plied  indefinitely,  and  those  desirous  of 
further  information  are  referred  more  espe- 
cially to  Simon's**  Papers  Relating  to  the  His- 
tory and  Practice  of  Vaccination,"  and  Mr. 
Hart's  excellent  compilation,  *'The  Truth 
about  Vaccination  " ;  but  enough  has  been 
supplied  for  the   purposes  of  this  chapter. 

Although  common  observation  and  irre- 
futable experience  have  long  since  recog- 
nized in  vaccination  an  invaluable  protec- 
tion against  small-pox,  the  brilliant  re- 
searches of  Pasteur  upon  the  prevention  of 
chicken  cholera  and  charbon  have  placed  the 
practice  of  vaccination,  in  its  broadest  sense, 
upon -a  basis  of  scientific  security,  which 
nothing  can  overturn.  However,  years  be- 
fore Pasteur's  discoveries  were  made  known, 
it  was  practically  demonstrated  that  sheep 
could  be  protected  from  sheep-pox  by  the 
inoculation  of  the  virus  of  that  disease,  and 
this  fact  was  recognized  and  made  use  of 
by  practical  men,  just  as  the  stock  raisers  of 
France  are  now  seeking  protection  against 
splenic  fever,  because  common  sense  and 
business  acumen  suggest  the  practice. 

While  '' anti-vaccinists "  are  constrained 
to  allow,  which  they  cannot  well  help  with 


OBJECTIONS  TO   VACCINATION.  131 


the  historical  data  before  them,  that  small- 
pox prevailed  to  a  much  greater  extent  in 
past  generations  than  now,  and  that  for  cer- 
tain reasons  its  virulence  has  much  dimin- 
ished, they  assign  as  a  cause  for  this 
diminution  the  influence  of  better  modes  of 
life,  improved  hygiene,  etc., — small-pox,  ac- 
cording to  them,  originating  de  novo  as  the 
result  of  insanitation.  This  unscientific  hy- 
pothesis, besides  ignoring  the  universally 
acknowledged  contagiousness  of  variola, 
sparing  none,  whatever  the  hygienic  sur- 
roundings, unless  protected  by  vaccination, 
does  not  take  into  account  the  fact,  as 
pointed  out  by  Martin,'^*  that  small-pox  did 
not  make  its  appearance  in  Europe  and 
Americaf  for  many  centuries,  although  all 
the  factors,  insanitation,  etc.,  existed  in  a 
more  marked  degree  than  now.  But  one 
of  the  most  striking  illustrations  of  the  in- 
validity of  this  argument,  and  incidentally 
of  the  power  of  vaccination  over  variola,  is 
supplied  by  the  state  of  affairs  which  ob- 

*  North  Amer.  Rev.,  April,  1882. 

f  Small-pox  appeared  first  in  Gern:iany  toward  the  end  of  the 
15th  century,  in  England  about  1241,  and  was  conveyed  to 
America  soon  after  the  discovery  of  the  new  world,  where  it 
was  totally  unknown  before. 


132  ESSENTIALS  OF  VACCINATION. 


tained  at  Andersonville,  a  military  prison  in 
the  South,  during  the  late  war.  It  is  said 
that  small-pox  was  twice  introduced  into 
Andersonville,  where  nearly  60,000  prisoners 
were  confined  under  the  most  unfavorable 
conditions,  but  owing  to  the  thorough  re- 
vaccination  of  the  soldiers  at  the  date  of 
enlistment,  not  more  than  a  dozen  deaths 
occurred. 

Alleged  Dangers  of  Vaccination. — 

It  has  been  urged  by  anti-vaccinists  that  the 
practice  of  vaccination  has  brought  a  multi- 
tude of  ills  upon  the  world,  which  are  far 
more  disastrous  than  small-pox.  It  is 
claimed  that  it  has  (^)  produced  new  diseases, 
(^)  that  it  has  led  to  an  increase  in  the  mor- 
tality of  existing  diseases,  (^)  that  glandular 
and  cutaneous  diseases  may  be  invaccinated, 
(^)  that  syphilis  may  be  invaccinated, 
and  (^)  that  certain  diseases  of  animals  may 
be  conveyed  by  bovine  vaccination. 

So  far  as  the  first  allegation  is  concerned 
it  may  be  dismissed  without  comment  as 
being  utterly  preposterous  and  unfounded. 
The  whole  idea  is  based  upon  the  grossest 
misconception  of  pathological  laws.  As  a 
medical  writer  has  said,  when  vaccinia  is  in- 


OBJECTIONS  TO  VACCINATION,  133 


oculated  it  produces  vaccinia  and  nothing 
else.  No  disease  is  more  frequently  inocu- 
lated than  syphilis,  but  no  one  ever  claimed 
that  its  introduction  into  the  system  caused 
anything  else  but  syphilis  and  its  sequelae. 

The  second  allegation  is  equally  without 
basis  of  fact,  but  as  statistics  have  been 
brought  to  its  support,  one  word  of  explana- 
tion maybe  necessary.  It  has  been  claimed 
that  certain  diseases,  such  as  measles  and 
scarlet  fever,  have  become  more  frequent 
and  more  malignant  since  the  introduction 
of  vaccination.  This  statement  possesses 
some  semblance  of  truth  ;  but  if  we  remem- 
ber that  small-pox  was,  and  is,  extremely 
fatal  in  childhood,  it  can  be  readily  under- 
stood that  vaccination,  by  diminishing  small- 
pox mortality,  leaves  a  larger  number  to  be 
attacked  by  other  diseases.  ''  Vaccination,'* 
says  Seaton,  '*  does  not  profess  to  make  man- 
kind immortal ;  it  saves  from  small-pox  and 
its  sequelae,  and  from  nothing  else ;  and  every- 
body whom  it  saves  therefrom  lives  to  die 
of  some  other  cause  at  some  future  period. 
One  might  as  well  argue  on  such  grounds 
against  saving  a  man  from  drowning. 

One    disease    especially,  scrofula,    which 


134  ESSENTIALS  OF  VACCINATION, 

vaccination  is  declared  tO'  have  increased, 
has  been  notably  diminished  since  its  intro- 
duction ;  for  scrofulous  and  tubercular  affec- 
tions were  well  recognized  as  the  most 
dreaded  and  frequent  sequelae  of  small-pox. 
Dr.  Farr,  the  eminent  statistician,  is  author- 
ity for  the  statement  that  the  mortality  from 
fever  has  progressively  subsided  since  1771, 
and  moreover  that  the  deaths  from  small- 
pox, scarlatina  and  measles  now  are  only 
half  so  great  as  the  mortality  formerly  oc- 
casioned by  small-pox  alone."^ 

The  occurrence  of  cutaneous  and  glandu- 
lar diseases  following  vaccination  has  been 
much  insisted  upon  by  anti-vaccinists.  That 
certain  trifling  eruptive  disorders  some- 
times follow  as  a  consequence  of  the  act 
of  vaccination  no  one  is  disposed  to  deny, 
and  that  latent  eczema  is  occasionally 
roused  into  activity  in  the  same  manner 
is  equally  true  ;  but  even  these  accidents 
are  rare,  as  can  be  attested  by  any  der- 
matologist, and  in  the  main  are  of  a  benign 
character,  and  might  as  readily  have  been 
provoked  by  any  other  exciting  cause.    The 

*  McCulloch's   Descriptive   and    Statistical    Account  of    the 
Brit.  Empire,  4th  Edit.,  Vol.  II,  quoted  in  Seaton's  Handbook. 


OBJECTIONS  TO  VACCINATION.  135 

cases  of  vaccinia  gangrsenosa  mentioned 
in  a  preceding  chapter,  were  perhaps  really 
the  result  of  vaccination,  but  not  neces^sarily 
of  competent  vaccination.  They  afford  no 
valid  argument  against  the  practice,  since 
evil  results  may  ensue  upon  any  ill-per- 
formed, or  even  well-performed,  act  in  life. 
The  honest  advocate  of  vaccination  has 
nothing  to  conceal. 

The  production  of  glandular  diseases  by 
vaccination,  as  asserted  by  anti-vaccinists, 
is  readily  explained  by  those  cases  of  ec- 
zema, which  may  or  may  not  have  been 
provoked  by  vaccination,  where  the  lym- 
phatic glands  become  sympathetically  in- 
volved. In  former  times,  and  not  uncom- 
monly in  ouc  own  day,  eczema  was  looked 
upon  as  an  expression  of  the  scrofulous 
diathesis,  with  which,  by  the  way,  it  has  no 
relation ;  and  its  more  or  less  frequent  coin- 
cidence with  vaccination,  most  children  be- 
ing vaccinated,  and  a  large  proportion  being 
subjects  of  '*  milk  crust,"  naturally  gave  rise 
to  the  erroneous  idea  that  scrofulous  and 
glandular  affections  were  in  some  way  de- 
pendent upon  vaccination. 

The    possibility  of  transmitting    syphilis 


136  ESSENTIALS  OF  VACCINATION. 

by  vaccination  has  been  amply  demon- 
strated, and  that,  too,  by  scientific  advocates 
of  vapcination.  That  so  prevalent  a  disease 
should  occasionally  be  inoculated  in  vaccin- 
ation is  not  to  be  wondered  at;  but  it  is 
perfectly  safe  to  say  that  syphilis  has  been 
less  frequently  conveyed  in  vaccination  than 
through  the  medium  of  kissing,  infected 
drinking-glasses,  pipes,  children's  whistles 
and  the  other  innumerable  ways  in  which  it 
may  be  propagated.  Vaccination  in  itself 
is  not  to  blame  for  the  transmission,  but  in 
nearly  all  instances  its  improper  perform- 
ance. Unquestioned  cases  of  vaccinal  syph- 
ilis are  exceedingly  rare,  for  many  vaccinators 
of  life-long  experience  have  never  met  with 
an  example  of  it.  Proper  car^and  discrim- 
ination in  the  selection  of  virus  would  make 
this  unfortunate  accident  well  nigh  impossi- 
ble, and  if  animal  lymph  were  exclusively 
employed,  altogether  impossible. 

There  is  no  evidence  that  any  of  the  dis- 
eases of  cattle  have  ever  been  communicated 
to  man  in  animal  vaccination.  The  experi- 
ences of  the  most  eminent  specialists  in  this 
direction,  notably  Warlomont  and  Martin, 
supply  no  such  instance.     Veterinarians  tell 


OBJECTIONS  TO  VACCINATION,  137 


US  that  by  unusual  negligence  such  diseases 
as  epizootic  eczema  and  perhaps  anthrax 
might  be  communicated.  Whether  bovine 
tuberculosis  may  be  communicated  through 
vaccine  lymph  or  the  accidental  admixture 
of  blood  with  the  lymph  cannot  be  affirmed, 
neither  can  it  be  absolutely  denied.  M. 
Warlomont  sums  up  the  whole  question  in 
a  happy  and  practical  manner,  as  follows  : 
"  Thus  it  may  be  affirmed  that  neither  syph- 
ilis nor  tuberculosis  nor  anthrax  nor  any 
diathetic  disease  can  be  inoculated  into  the 
human  race  by  animal  vaccination.  This 
however  is  dependent  upon  one  condition, 
which  is  that  the  vaccine,  whether  living  or 
preserved,  should  be  taken  from  a  healthy 
animal  and  collected  at  the  required  moment. 
This  is  the  A  B  C  of  the  whole  question."*'^ 
Absolute  protection  against  small-pox 
does  not  exist,  for  either  natural  small-pox 
or  the  inoculated  disease  may  be  followed 
by  subsequent  attacks  ;  therefore,  it  cannot 
be  expected  that  vaccination  will  prove  a 
more  effective  preventive  of  small-pox  than 
small-pox  itself;  but  the  practice  of  vacci- 
nation affords,  when  duly  and  efficiently  per- 

*  British  Med.  Jour.,  November  12,  1881. 


138  ESSENTIALS  OF  VACCINATION, 

formed,  which  means,  of  course,  that  the 
operation  be  done  in  the  best  manner,  with 
the  best  lymph,  and  sufficiently  often,  a 
protection  that  is  practically  absolute. 

No  one  would  wish  to  deny  that  vaccina- 
tion, as  ordinarily  administered,  has  its  draw- 
backs, and  even  its  dangers  ;  but  compared 
with  the  millions  of  cases  in  which  favora- 
ble results  are  obtained,  and  having  in  view 
the  ends  to  be  attained,  the  disadvantages 
are  most  trifling.  Were  we,  says  Cursch- 
mann,  to  neglect  vaccination  on  this  account 
it  would  be  about  as  wise  as  to  refuse  to 
travel  by  the  railroad  for  fear  of  possibly 
running  off  the  track. 

Every  unbiased  mind  must  acknowledge 
the  blessing  that  vaccination  has  been  to 
the  human  race,  and  our  constant  effort 
should  be,  while  reforming  such  evils  as 
may  exist,  to  so  extend  its  practical  useful- 
ness that  in  the  course  of  time,  the  noble 
dream  of  Jenner — -the  total  extinction  of 
small-pox  —  may  be  realized. 


INDEX. 


Abscess,  circumscribed,  after  vaccination,  52. 

Adenitis,  specific,  in  vaccinia,  41. 

Age  of  person  to  be  vaccinated,  103. 

Animal  vaccination,  15  ;  definition  of,  15  ;  Martin  on, 

15;  in  Italy,  16;  advantages  of,  78;  disadvantages 

of,  82. 
Animal  variola,  17. 
Anti-vaccinists,  theories  of,  130. 
Areola,  the,  40. 
Aseptic  lymph,  96. 
Atkinson  on  long  incubation  of  vaccinia,  43. 

Badcock  on  variolation  of  kine,  32. 

Beaugency  virus,  16. 

Behrend  on  vaccinal  eruptions,  53;  on  roseola,  54. 

Benoit  on  perservation  of  lymph,  97. 

Blood  the,  in  vaccinia,  36;  in  bovine  virus,  89. 

Bluish  or  black  pock,  23. 

Bollinger  on  influence  of  vaccinia  on  the  foetus,  38. 

Bouley  on  horse-pox,  25. 

Bovine  diseases  in  vaccination,  136. 

Bovine  virus,  influence  of,  on  vaccinal  process,  43 ;  so- 
called  violence  of,  76;  advantages  of,  78;  taking 
qualities  of,  79 ;  disadvantages  of,  82  ;  methods  of 
obtaining  and  storing,  88  ;  propagation  of,  84  ;  Foster 
on,  84 ;  Law  on,  84 ;  when  to  collect,  87  ;  on  blood 
in,  89  ;  crusts  of,  90 ;  capillary  tubes  for,  90  ;  points 
and  slips  for,  91 ;  keeping  quality  of  dry,  92. 

Braidwood  and  Vacher  on  aseptic  lymph,  96. 

Bryce's  test,  44. 


140  INDEX. 


Buchanan    on    comparative    death-rate    in    small-pox, 
122  ;  table  showing  value  of  efficient  vaccination,  126. 
Bullae  after  vaccination,  49. 

Burckhardt,  influence  of  vaccinia  on  the  foetus,  2>^, 
Byerly  on  vaccinia  revived,  46. 

Calf-to-arm  vaccination,  92. 

Cameron  on  degeneration  of  humanized  lymph,  74. 

Capillary  tubes  for   bovine  virus,    90 ;  for   humanized 

virus,  96. 
Carpenter  on  vaccination,  32. 
Ceely  on  cow-pox,  20;  on    spurious  cow-pox,  22;  on 

sheep-pox,  27  ;  on  variolation  of  cows,  32  ;  on  gen- 
eralized vaccinia,  57. 
Chauveau  on  virulence  of  sheep-pox,  26 ;  on  nature  of 

vaccinia,  29. 
China,  inoculation  for  small-pox  in,  9. 
Cicatrix,  the  vaccine,  42  ;  area  of,  113. 
Complications  of  vaccinia,  48. 
Condition  of  persons  to  be  vaccinated,  102. 
Contra-indications  to  vaccination,  102. 
Cones,  patent  lymph,  92. 
Cow-pox,  popular  belief  concerning,  12;  natural,  18; 

history  of,    19;  Newham  on,   19;  spontaneous,   19; 

less  frequence  of,  20;  Ceely  on,  20;  spurious,  22; 

symptoms  of,  20 ;  independence  of,  from  horse-pox, 

25  ;  relationship  to  human  variola,  29. 
Curschmann  on  vaccine  and  glycerine  mixture,  95. 

Day  on  paralysis  after  vaccination,  52. 
Desiccation,  period  of,  41. 

Eczema  after  vaccination,  56,  134. 

Equination,  23. 

Equine-pox,  23. 

Eruptions,  vaccinal,  53. 

Erysipelas  after  vaccination,  50;  causes  of,  51. 

Erythema  multiforme  after  vaccination,  55. 


INDEX.  141 


Farr  on  decrease  of  infectious  diseases,  134. 

Fleming  on  human  and  animal  variola,  18;  on  vaccinia 
in  bulls,  20 ;  on  nature  of  vaccinia,  30. 

Foetus,  influence  of  vaccinia  on,  38. 

Foster  on  the  vaccinal  process,  43 ;  on  vaccinal  syphi- 
lis, 60. 

France,  introduction  of  vaccination  into,  14. 
Franco-Prussian  war,  vaccination  in,  128. 

Gast,  on  influence  of  vaccinia  on  the  foetus,  39 ;  on 

vaccination  of  pregnant  women,  103. 
Generalized  vaccinia,  56. 
Glandular  diseases  after  vaccination,  135. 
Grease,  the,  24 ;  Loy  on  difference  between  horse-pox 

and,  25;  Jenner  on,  24. 
Gregory  on  small-pox  inoculation,  9 ;  on  purpura  after 

vaccination,  55. 

Hardy  on  generalized  vaccinia,  57. 

Hart's  statistics  of  animal  vaccinations,  80. 

Hebra  on  the  swelling  of  parotid  and  submaxillary 
glands,  52;  on  roseola  vaccinia,  54. 

Heifer-transmitted  cow-pox  virus,  15. 

Herpetic  vesicles  after  vaccination,  49. 

H^ing  on  cow-pox,  26. 

History  of  vaccination,  9. 

Horse-pox,  23;  independence  of,  from  cox-pox,  25. 

Humanized  virus,  disadvantages  of,  77  ;  time  of  col- 
lecting, 93  ;  crust  of,  94;  methods  of  storing,  94-98. 

Hutchinson  on  vaccinia  gangraenosa,  55  ;  on  vaccinal 
syphilis,  59. 

Incubation,  long  period  of,  43. 

Inoculation  for  small-pox,  9  ;  how  to  perform,  10. 

Inspection  of  vaccine  results,  114. 

Insusceptibility  of  vaccinia,  46. 

Ivory  points  for  bovine  virus,  91. 


142  INDEX. 


Jefferson,  'J'homas,  advocate  of  vaccination,  14. 

Jenner,  vaccination  and,  10;  birth  of,  11;  first  essay, 
13;  death  of,  15  ;  on  the  grease,  24  ;  on  decay  of  vac- 
cine influence,  73. 

Jesty,  Benjamin,  early  vaccinator,  11. 

Keyes  on  vaccinal  syphilis,  58. 
Kine,  variolation  of,  31. 

Lafosse  on  horse-pox,  25. 

Lindley  on  vaccination,  74. 

Loy  on  the  grease,  25. 

Lymphatic  absorption  in  vaccinia,  35-36. 

Lymphatic  ganglia  in  vaccinia,  37  ;  suppuration  of,  44. 

Lymphatic  vessels  in  vaccinia,  36. 

Macaulay  on  small-pox  in  seventeenth  century,  117. 
Marson  on  vaccinating,  99  ;  on  immediate  vaccination, 

106  ;  statistics  of  vaccination,  11 1  ;  on  small-pox  in 

London  Hospital,  121. 
Martin  on  animal  vaccination,  15  ;  statistics  of  animal 

vaccination,  80;  transmission  of  bovine  disease  by 

vaccination,  136. 
Maunoury  on  horse-pox,  25. 
Mexico,  vaccination  in,  11. 
Montague,  Lady,  on  small-pox  inoculation,  10. 
Mliller  on  vaccine  and  glycerine  mixture,  95. 

Natural  cow-pox,  18. 

Nervous  system  in  vaccinia,  2,^. 

Newham  on  cow-pox  in  England,  19. 

Objections  to  vaccination,  116. 
Operation  of  vaccinating,  99. 
Otitis  after  vaccination,  52. 
Papule  of  vaccinia,  40. 


INDEX,  143 


Pasteur  on  attenuation  of  viruses,  32  ;  vaccination  of 

lambs,  39. 
Pigeon  variola,  28. 
Plett,  early  vaccinator,  11. 
Pott  on  aseptic  lymph,  96. 
Preventive  viruses,  9. 
Pregnancy,  vaccinia  in,  38,  103. 
Puncture,  vaccination  by,  108. 
Purpura  after  vaccination,  55. 
Pustule  of  vaccinia,  41. 
Pyaemia  after  vaccination,  52. 
Pylarini  on  small-pox  inoculation,  10. 

Quill  slips  for  bovine  virus,  91. 

Raynaud  on  vaccine  infection,  36;  on  specific  adenitis 
in  vaccinia,  41. 

Reiter  on  dilution  of  vaccine  lymph,  95. 

Retardation  of  vaccinia,  43. 

Retro-vaccination,  23. 

Revaccination,  course  of,  64;  Meyer  on,  64;  constitu- 
tional symptoms  in,  65  ;  what  constitutes  a,  65  ; 
Niemeyer  on,  66 ;  frequency  of,  67  ;  importance  of, 
67  ;  Welch  on,  69. 

Roseola  of  vaccinia,  54. 

Russell  on  number  of  insertions,  112. 

Sacco,  Luigi,  early  Italian  vaccinator,  14. 

Savory  on  pyaemia  after  vaccination,  52. 

Scarification,  vaccination  by,  109. 

Scrofula  and  vaccination,  133. 

Seaton  on  dry  lymph,  44;  on  lymph  and  glycerine,  95  ; 

on  immediate  vaccination,  105  ;  table  showing  value 

of  efficient  vaccination,  126. 
Sheep-pox,  26. 

Shepherd  on  vaccinia  revived,  46. 
Small-pox,  attenuation  of  virus,  32  ;  inoculation  for,  9; 

in  animals,  17-27;  relationship  of,  to  vaccinia,  29; 


144  INDEX, 


vaccinia  after,  45;  influence  of  vaccinia  upon,  61; 

protection  against,  117;  in  seventeenth  century,  117  ; 

vaccination  during  incubation  of,  105  ;  inoculation  of, 

after  vaccination,  119;  death  rate  in  London  from, 

122. 
Smith,  J.  L.,  on  vaccinal  erysipelas,  50. 
Spencer  on  otitis  after  vaccination,  52. 
Spontaneous  cow-pox,  19. 
Spurious  cow-pox,  22. 
Spurious  vaccination,  48. 
Stokes  on  vaccinia  gangrsenosa,  55. 
Slilzer,  early  writer  on  vaccination,  11. 
Sutton  and  Fewster,  early  writers  on  vaccination,  11. 
Syphilis  after  vaccination,  57,  78,  135.- 

Tattooing,  vaccination  by,  109. 

Taylor  on  infected  vaccinators,  59. 

Thiele  on  variolation  of  cows,  32;  on  attenuation  of 

small-pox  virus,  32. 
Timoni  on  small-pox  inoculation,  9. 
Tubercles  after  vaccination,  48. 
Tuberculosis,  bovine,  137. 

Ulcers  after  vaccination,  50. 
Umbilication  of  vaccine  vesicle,  40. 

Vaccinal  eruptions,  53;  causes  of,  53. 

Vaccinal  syphilis,  57,  78,  135. 

Vaccination,  history  of,  9  ;  and  Jenner,  9 ;  Humboldt 
on,  10;  Slilzer  on,  11;  Sutton  and  Fewster  on,  11; 
popular  belief  concerning,  12  ;  Jesty  and,  11 ;  Plett 
and,  11;  first  operation  of,  13;  first  essay  on,  13; 
early  career  of,  14;  introduced  into  America,  14; 
introduced  into  France,  14;  origin  of  term,  15;  ani- 
mal, 15;  Carpenter  on,  32;  of  lambs,  39;  herpetic 
vesicles  after,  49 ;  ulcers  after,  50 ;  erysipelas  after,  50 ; 
pyaemia  after,  52  ;  paralysis  after,  52  ;  otitis  after,  52  ; 
eruptions  after,  53;  erythema  multiforme  after,  55 ; 


INDEX.  145 

purpura  after,  55;  vaccinia  gangraenosa  after,  55; 
eczema  after,  56,  134;  eczema  cured  by,  56;  syphilis 
after,  57,  78,  135;  Lindley  on,  74;  contra-indications 
to,  102;  in  America,  100;  immediate  when  neces- 
sary, 105  ;  by  puncture,  108;  by  tattooing,  109;  by 
scarification,  109;  quality  of,  in,  amount  of,  iii; 
inspection  of  results  of,  114;  examination  of  objec- 
tion to,  116;  protection  afforded  by,  117;  small-pox 
before  discovery  of,  11 8-1 19;  in  Bombay,  121; 
small-pox  death-rate  influenced  by,  118;  inocula- 
tion of  small-pox  after,  119;  comparative  effects  of, 
121;  table  showing  value  of  efficient,  126;  neces- 
sity of  thorough,  125;  in  Franco-Prussian  war,  128; 
Welch  on,  129;  alleged  dangers  of,  132;  scrofula 
and,  132;  eczema  and,  134;  syphilis  and,  135;  glan- 
dular diseases  and,  135;  transmission  of  bovine  dis- 
eases by,  136. 

Vaccine  virus  in  U.  S.,  16;  contagium  of,  35 ;  merits 
of  different  kinds  of,  71;  degeneration  of,  72;  with 
glycerine,  95. 

Vaccinia,  nature  of,  29 ;  Chauveau  on,  29 ;  identity  of 
with  human  variola,  29 ;  mode  of  infection  in,  35  ; 
pustule  of,  41;  Raynaud  on,  2,^\  lymphatic  absorp- 
tion in,  36;  nervous  system  in,  36;  the  blood  in, 
36;  the  lymphatic  vessels  and  ganglions  in,  36-37, 
pregnancy  during,  37;  influence  of,  on  foetus,  38; 
in  the  human  subject,  40 ;  symptoms  and  course  of, 
40;  structure  of  lesion  of,  40  ;  vesicle  of,  40;  areola 
in,  40;  umbilication  in,  40;  lymphatic  glands  in,  41 ; 
desiccation  in,  41;  crust  in,  41;  cicatrix  in,  42; 
normal  deviations  in,  42  ;  retardation  of,  43 ;  incu- 
bation of,  43  ;  constitutional  symptoms  of,  44 ;  sup- 
puration of  lymphatic  glands,  44;  after  small-pox, 
45  ;  revived,  46  ;  insusceptibility  of,  46  ;  parotid  and 
submaxillary  glands  in,  52;  eruptions  during,  53; 
gangraenosa,  55;  generalized,  56;  influence  of  other 
diseases  on,  60 ;  influence  of  small-pox  on,  61 ;  causes 
of  irregularity  in,  62. 

Variola  ovina.  26. 


146  INDEX. 


Variolas  vaccinae,  13. 

Variola-vaccine,  33. 

Variolation,  23. 

Vesicle  of  vaccinia,  40;  supernumerary,  56. 

Viborg  on  horse-pox,  25. 

Viennois  on  vaccinal  syphilis,  58. 

Warlomont  on  statistics  of  successful  vaccination,  79, 
on  capillary  tubes  for  bovine  virus,  90;  on  transmis- 
sion of  animal  diseases  by  vaccination,  137. 

Waterhouse,  first  American  vaccinator,  14.' 

Watson  on  vaccinia  revived,  46. 

Welch  on  vaccination  in  Franco-Prussian  war,  128  ;  on 
revaccination,  69,  129. 

White  pock,  23. 

Wilson  on  the  stages  of  vaccinia,  42. 

Wood  on  non-identity  of  variola  and  vaccinia,  31. 


Yellow  pock,  23. 


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